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Buiteman-Kruizinga LA, Serpa Neto A, Botta M, List SS, de Boer BH, van Velzen P, Bühler PK, Wendel Garcia PD, Schultz MJ, van der Heiden PLJ, Paulus F. Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial. PLoS One 2024; 19:e0307155. [PMID: 39078857 PMCID: PMC11288413 DOI: 10.1371/journal.pone.0307155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/29/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Mechanical power of ventilation, a summary parameter reflecting the energy transferred from the ventilator to the respiratory system, has associations with outcomes. INTELLiVENT-Adaptive Support Ventilation is an automated ventilation mode that changes ventilator settings according to algorithms that target a low work-and force of breathing. The study aims to compare mechanical power between automated ventilation by means of INTELLiVENT-Adaptive Support Ventilation and conventional ventilation in critically ill patients. MATERIALS AND METHODS International, multicenter, randomized crossover clinical trial in patients that were expected to need invasive ventilation > 24 hours. Patients were randomly assigned to start with a 3-hour period of automated ventilation or conventional ventilation after which the alternate ventilation mode was selected. The primary outcome was mechanical power in passive and active patients; secondary outcomes included key ventilator settings and ventilatory parameters that affect mechanical power. RESULTS A total of 96 patients were randomized. Median mechanical power was not different between automated and conventional ventilation (15.8 [11.5-21.0] versus 16.1 [10.9-22.6] J/min; mean difference -0.44 (95%-CI -1.17 to 0.29) J/min; P = 0.24). Subgroup analyses showed that mechanical power was lower with automated ventilation in passive patients, 16.9 [12.5-22.1] versus 19.0 [14.1-25.0] J/min; mean difference -1.76 (95%-CI -2.47 to -10.34J/min; P < 0.01), and not in active patients (14.6 [11.0-20.3] vs 14.1 [10.1-21.3] J/min; mean difference 0.81 (95%-CI -2.13 to 0.49) J/min; P = 0.23). CONCLUSIONS In this cohort of unselected critically ill invasively ventilated patients, automated ventilation by means of INTELLiVENT-Adaptive Support Ventilation did not reduce mechanical power. A reduction in mechanical power was only seen in passive patients. STUDY REGISTRATION Clinicaltrials.gov (study identifier NCT04827927), April 1, 2021. URL OF TRIAL REGISTRY RECORD https://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1.
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Affiliation(s)
- Laura A. Buiteman-Kruizinga
- Department of Intensive Care, Reinier de Graaf Hospital, Delft, the Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers ‘Location AMC’, Amsterdam, the Netherlands
| | - Ary Serpa Neto
- Department of Intensive Care, Amsterdam University Medical Centers ‘Location AMC’, Amsterdam, the Netherlands
- Australian and New Zealand Intensive Care–Research Centre (ANZIC–RC), Monash University, Melbourne, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Michela Botta
- Department of Intensive Care, Amsterdam University Medical Centers ‘Location AMC’, Amsterdam, the Netherlands
| | - Stephanie S. List
- Department of Intensive Care, Dijklander Hospital ‘Location Hoorn’, Hoorn, the Netherlands
| | - Ben H. de Boer
- Department of Intensive Care, Dijklander Hospital ‘Location Hoorn’, Hoorn, the Netherlands
| | - Patricia van Velzen
- Department of Intensive Care, Dijklander Hospital ‘Location Hoorn’, Hoorn, the Netherlands
| | - Philipp Karl Bühler
- Institute of Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland
| | | | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers ‘Location AMC’, Amsterdam, the Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Anesthesia, General Intensive Care and Pain Management, Medical University Wien, Vienna, Austria
| | | | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers ‘Location AMC’, Amsterdam, the Netherlands
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Alay GH, Tatlisuluoglu D, Turan G. Evaluation of IntelliVent-ASV® and PS-SIMV Mode Using Ultrasound (US) Measurements in Terms of Diaphragm Atrophy. Cureus 2023; 15:e40244. [PMID: 37309540 PMCID: PMC10257811 DOI: 10.7759/cureus.40244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Mechanical ventilation is a life-saving intervention for critically ill patients, but it can also lead to diaphragm atrophy, which may prolong the duration of mechanical ventilation and the length of stay in the intensive care unit. IntelliVent-ASV® (Hamilton Medical, Rhäzüns, Switzerland) is a new mode of ventilation that has been developed to reduce diaphragm atrophy by promoting spontaneous breathing efforts. In this study, we aimed to evaluate the effectiveness of IntelliVent-ASV® and pressure support-synchronized intermittent mandatory ventilation (PS-SIMV) mode in reducing diaphragm atrophy by measuring diaphragm thickness using ultrasound (US) imaging. METHODS We enrolled 60 patients who required mechanical ventilation due to respiratory failure and were randomized into two groups: IntelliVent-ASV® and PS-SIMV. We measured the diaphragm thickness using US imaging at admission and on the seventh day of mechanical ventilation. RESULTS Our results showed that diaphragm thickness decreased significantly in the PS-SIMV group but remained unchanged in the IntelliVent-ASV® group. The difference in diaphragm thickness between the two groups was statistically significant on the seventh day of mechanical ventilation. CONCLUSIONS IntelliVent-ASV® may reduce diaphragm atrophy by promoting spontaneous breathing efforts. Our study suggests that this new mode of ventilation may be a promising approach to preventing diaphragm atrophy in mechanically ventilated patients. Further studies using invasive measures of diaphragm function are warranted to confirm these findings.
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Affiliation(s)
- Gulcin Hilal Alay
- Intensive Care Unit, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, TUR
| | - Derya Tatlisuluoglu
- Intensive Care Unit, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, TUR
| | - Guldem Turan
- Intensive Care Unit, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, TUR
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Buiteman-Kruizinga LA, Schultz MJ. The (Mechanical) Power of (Automated) Ventilation. Respir Care 2023; 68:556. [PMID: 36963969 PMCID: PMC10173124 DOI: 10.4187/respcare.10531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
- Laura A Buiteman-Kruizinga
- Department of Intensive CareReinier de Graaf HospitalDelft, the NetherlandsDepartment of Intensive CareAmsterdam University Medical CentersLocation "AMC"Amsterdam, the Netherlands
| | - Marcus J Schultz
- Department of Intensive CareAmsterdam University Medical Centers Location "AMC"Amsterdam, the NetherlandsMahidol-Oxford Tropical Medicine Research UnitMahidol UniversityBangkok, ThailandNuffield Department of MedicineUniversity of OxfordOxford, United Kingdom
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Abstract
PURPOSE OF REVIEW The last 25 years have seen considerable development in modes of closed-loop ventilation and there are now several of them commercially available. They not only offer potential benefits for the individual patient, but may also improve the organization within the intensive care unit (ICU). Clinicians are showing both greater interest and willingness to address the issues of a caregiver shortage and overload of bedside work in the ICU. This article reviews the clinical benefits of using closed-loop ventilation modes, with a focus on control of oxygenation, lung protection, and weaning. RECENT FINDINGS Closed-loop ventilation modes are able to maintain important physiological variables, such as oxygen saturation measured by pulse oximetry, tidal volume (VT), driving pressure (ΔP), and mechanical power (MP), within target ranges aimed at ensuring continuous lung protection. In addition, these modes adapt the ventilator support to the patient's needs, promoting diaphragm activity and preventing over-assistance. Some studies have shown the potential of these modes to reduce the duration of both weaning and mechanical ventilation. SUMMARY Recent studies have primarily demonstrated the safety, efficacy, and feasibility of using closed-loop ventilation modes in the ICU and postsurgery patients. Large, multicenter randomized controlled trials are needed to assess their impact on important short- and long-term clinical outcomes, the organization of the ICU, and cost-effectiveness.
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Affiliation(s)
- Jean-Michel Arnal
- Service de réanimation polyvalente, Hôpital Sainte Musse, Toulon, France
- Department of Research and New Technologies, Hamilton Medical, Bonaduz, Switzerland
| | - Shinshu Katayama
- Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Christopher Howard
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
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Baedorf Kassis EN, Bastos AB, Schaefer MS, Capers K, Hoenig B, Banner-Goodspeed V, Talmor D. Adaptive Support Ventilation and Lung-Protective Ventilation in ARDS. Respir Care 2022; 67:1542-1550. [PMID: 35973716 PMCID: PMC9994029 DOI: 10.4187/respcare.10159] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adaptive support ventilation (ASV) is a partially closed-loop ventilation mode that adjusts tidal volume (VT) and breathing frequency (f) to minimize mechanical work and driving pressure. ASV is routinely used but has not been widely studied in ARDS. METHODS The study was a crossover study with randomization to intervention comparing a pressure-regulated, volume-targeted ventilation mode (adaptive pressure ventilation [APV], standard of care at Beth Israel Deaconess Medical Center) set to VT 6 mL/kg in comparison with ASV mode where VT adjustment is automated. Subjects received standard of care (APV) or ASV and then crossed over to the alternate mode, maintaining consistent minute ventilation with 1-2 h in each mode. The primary outcome was VT corrected for ideal body weight (IBW) before and after crossover. Secondary outcomes included driving pressure, mechanics, gas exchange, mechanical power, and other parameters measured after crossover and longitudinally. RESULTS Twenty subjects with ARDS were consented, with 17 randomized and completing the study (median PaO2 /FIO2 146.6 [128.3-204.8] mm Hg) and were mostly passive without spontaneous breathing. ASV mode produced marginally larger VT corrected for IBW (6.3 [5.9-7.0] mL/kg IBW vs 6.04 [6.0-6.1] mL/kg IBW, P = .035). Frequency was lower with patients in ASV mode (25 [22-26] breaths/min vs 27 [22-30)] breaths/min, P = .01). In ASV, lower respiratory-system compliance correlated with smaller delivered VT/IBW (R2 = 0.4936, P = .002). Plateau (24.7 [22.6-27.6] cm H2O vs 25.3 [23.5-26.8] cm H2O, P = .14) and driving pressures (12.8 [9.0-15.8] cm H2O vs 11.7 [10.7-15.1] cm H2O, P = .29) were comparable between conventional ventilation and ASV. No adverse events were noted in either ASV or conventional group related to mode of ventilation. CONCLUSIONS ASV targeted similar settings as standard of care consistent with lung-protective ventilation strategies in mostly passive subjects with ARDS. ASV delivered VT based upon respiratory mechanics, with lower VT and mechanical power in subjects with stiffer lungs.
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Affiliation(s)
- Elias N Baedorf Kassis
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | | | - Maximillian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Krystal Capers
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Valerie Banner-Goodspeed
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Buiteman-Kruizinga LA, Serpa Neto A, Schultz MJ. Automation to improve lung protection. Intensive Care Med 2022; 48:943-946. [PMID: 35593938 PMCID: PMC9273559 DOI: 10.1007/s00134-022-06719-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/23/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Laura A Buiteman-Kruizinga
- Department of Intensive Care, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands.
- Department of Intensive Care, Amsterdam University Medical Centers, location 'AMC', Amsterdam, The Netherlands.
| | - Ary Serpa Neto
- Department of Intensive Care, Amsterdam University Medical Centers, location 'AMC', Amsterdam, The Netherlands
- Australian and New Zealand Intensive Care-Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, location 'AMC', Amsterdam, The Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Research and Development, Hamilton Medical AG, Bonaduz, Switzerland
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Buiteman-Kruizinga LA, Mkadmi HE, Serpa Neto A, Kruizinga MD, Botta M, Schultz MJ, Paulus F, van der Heiden PL. Effect of INTELLiVENT-ASV versus Conventional Ventilation on Ventilation Intensity in Patients with COVID-19 ARDS-An Observational Study. J Clin Med 2021; 10:jcm10225409. [PMID: 34830691 PMCID: PMC8622732 DOI: 10.3390/jcm10225409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
Driving pressure (ΔP) and mechanical power (MP) are associated with outcomes in critically ill patients, irrespective of the presence of Acute Respiratory Distress Syndrome (ARDS). INTELLiVENT-ASV, a fully automated ventilatory mode, controls the settings that affect ΔP and MP. This study compared the intensity of ventilation (ΔP and MP) with INTELLiVENT-ASV versus conventional ventilation in a cohort of COVID-19 ARDS patients in two intensive care units in the Netherlands. The coprimary endpoints were ΔP and MP before and after converting from conventional ventilation to INTELLiVENT-ASV. Compared to conventional ventilation, INTELLiVENT-ASV delivered ventilation with a lower ΔP and less MP. With conventional ventilation, ΔP was 13 cmH2O, and MP was 21.5 and 24.8 J/min, whereas with INTELLiVENT-ASV, ΔP was 11 and 10 cmH2O (mean difference –2 cm H2O (95 %CI –2.5 to –1.2 cm H2O), p < 0.001) and MP was 18.8 and 17.5 J/min (mean difference –7.3 J/Min (95% CI –8.8 to –5.8 J/min), p < 0.001). Conversion from conventional ventilation to INTELLiVENT-ASV resulted in a lower intensity of ventilation. These findings may favor the use of INTELLiVENT-ASV in COVID-19 ARDS patients, but future studies remain needed to see if the reduction in the intensity of ventilation translates into clinical benefits.
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Affiliation(s)
- Laura A. Buiteman-Kruizinga
- Department of Intensive Care, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands;
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands; (A.S.N.); (M.B.); (M.J.S.); (F.P.)
- Correspondence: ; Tel.: +31-152604040
| | - Hassan E. Mkadmi
- Department of Research, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands;
| | - Ary Serpa Neto
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands; (A.S.N.); (M.B.); (M.J.S.); (F.P.)
- Australian and New Zealand Intensive Care–Research Centre (ANZIC–RC), Monash University, Melbourne, VIC 3004, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | - Matthijs D. Kruizinga
- Department of Pediatrics, Juliana Children’s Hospital, 2545 AA The Hague, The Netherlands;
| | - Michela Botta
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands; (A.S.N.); (M.B.); (M.J.S.); (F.P.)
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands; (A.S.N.); (M.B.); (M.J.S.); (F.P.)
- Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands; (A.S.N.); (M.B.); (M.J.S.); (F.P.)
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, 1105 AZ Amsterdam, The Netherlands
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