Feasibility study on full closed-loop control ventilation (IntelliVent-ASV™) in ICU patients with acute respiratory failure: a prospective observational comparative study

IntroductionIntelliVent-ASV™ is a full closed-loop ventilation mode that automatically adjusts ventilation and oxygenation parameters in both passive and active patients. This feasibility study compared oxygenation and ventilation settings automatically selected by IntelliVent-ASV™ among three predefined lung conditions (normal lung, acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD)) in active and passive patients. The feasibility of IntelliVent-ASV™ use was assessed based on the number of safety events, the need to switch to conventional mode for any medical reason, and sensor failure.MethodThis prospective observational comparative study included 100 consecutive patients who were invasively ventilated for less than 24 hours at the time of inclusion with an expected duration of ventilation of more than 12 hours. Patients were ventilated using IntelliVent-ASV™ from inclusion to extubation. Settings, automatically selected by the ventilator, delivered ventilation, respiratory mechanics, and gas exchanges were recorded once a day.ResultsRegarding feasibility, all patients were ventilated using IntelliVent-ASV™ (392 days in total). No safety issues occurred and there was never a need to switch to an alternative ventilation mode. The fully automated ventilation was used for 95% of the total ventilation time. IntelliVent-ASV™ selected different settings according to lung condition in passive and active patients. In passive patients, tidal volume (VT), predicted body weight (PBW) was significantly different between normal lung (n = 45), ARDS (n = 16) and COPD patients (n = 19) (8.1 (7.3 to 8.9) mL/kg; 7.5 (6.9 to 7.9) mL/kg; 9.9 (8.3 to 11.1) mL/kg, respectively; P 0.05). In passive ARDS patients, FiO2 and positive end-expiratory pressure (PEEP) were statistically higher than passive normal lung (35 (33 to 47)% versus 30 (30 to 31)% and 11 (8 to 13) cmH2O versus 5 (5 to 6) cmH2O, respectively; P< 0.05).ConclusionsIntelliVent-ASV™ was safely used in unselected ventilated ICU patients with different lung conditions. Automatically selected oxygenation and ventilation settings were different according to the lung condition, especially in passive patients.Trial RegistrationClinicalTrials.gov: NCT01489085

[1]  S. Jaber,et al.  Prospective Randomized Crossover Study of a New Closed-loop Control System versus Pressure Support during Weaning from Mechanical Ventilation , 2013, Anesthesiology.

[2]  Matthias Briel,et al.  Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. , 2010, JAMA.

[3]  E. de Jonge,et al.  Clinicians’ response to hyperoxia in ventilated patients in a Dutch ICU depends on the level of FiO2 , 2010, Intensive Care Medicine.

[4]  C. Natanson,et al.  Mechanical ventilation in ARDS: One size does not fit all. , 2005, Critical care medicine.

[5]  G. Rubenfeld,et al.  Barriers to providing lung-protective ventilation to patients with acute lung injury , 2004, Critical care medicine.

[6]  D. Tassaux,et al.  Patient-ventilator interactions during partial ventilatory support: A preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support , 2002, Critical care medicine.

[7]  M. Wysocki,et al.  Safety and efficacy of a fully closed-loop control ventilation (IntelliVent-ASV®) in sedated ICU patients with acute respiratory failure: a prospective randomized crossover study , 2012, Intensive Care Medicine.

[8]  M. Weatherall,et al.  Routine use of oxygen in the treatment of myocardial infarction: systematic review , 2008, Heart.

[9]  M. Dojat,et al.  A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. , 2006, American journal of respiratory and critical care medicine.

[10]  Effects of Implementing Adaptive Support Ventilation in a Medical Intensive Care Unit , 2011, Respiratory Care.

[11]  Peter J Pronovost,et al.  Patient and intensive care unit organizational factors associated with low tidal volume ventilation in acute lung injury* , 2008, Critical care medicine.

[12]  Andrés Esteban,et al.  Acute respiratory distress syndrome: Underrecognition by clinicians and diagnostic accuracy of three clinical definitions* , 2005, Critical care medicine.

[13]  M. Wysocki,et al.  Automatic selection of breathing pattern using adaptive support ventilation , 2007, Intensive Care Medicine.

[14]  J. Revelly,et al.  Adaptive Support Ventilation for Fast Tracheal Extubation after Cardiac Surgery: A Randomized Controlled Study , 2001, Anesthesiology.

[15]  Marek Ancukiewicz,et al.  Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. , 2009, The New England journal of medicine.

[16]  Arthur S Slutsky,et al.  What Tidal Volumes Should Be Used in Patients without Acute Lung Injury? , 2007, Anesthesiology.

[17]  P. Solomon,et al.  Meta-analysis of controlled trials of ventilator therapy in acute lung injury and acute respiratory distress syndrome: an alternative perspective , 2005, Intensive Care Medicine.

[18]  M. Underwood,et al.  Randomized Controlled Trial Comparing Adaptive-support Ventilation with Pressure-regulated Volume-controlled Ventilation with Automode in Weaning Patients after Cardiac Surgery , 2008, Anesthesiology.

[19]  Saxon Ridley.  Critical care. , 2003, Anaesthesia.

[20]  Robert M. Kacmarek,et al.  The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation , 2011, Intensive Care Medicine.

[21]  Michael P Young,et al.  Ventilation of patients with acute lung injury and acute respiratory distress syndrome: Has new evidence changed clinical practice?* , 2004, Critical care medicine.

[22]  W. Bailey,et al.  Editorial: Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 Guidelines for COPD, Including COVID-19, Climate Change, and Air Pollution , 2023, Medical science monitor : international medical journal of experimental and clinical research.

[23]  T. Floyd,et al.  Independent cerebral vasoconstrictive effects of hyperoxia and accompanying arterial hypocapnia at 1 ATA. , 2003, Journal of applied physiology.

[24]  J. Nicolás,et al.  Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. , 2006, American journal of respiratory and critical care medicine.

[25]  M. Lamy,et al.  Report of the American-European Consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Consensus Committee. , 1994, Journal of critical care.

[26]  Massimo Cressoni,et al.  Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. , 2008, American journal of respiratory and critical care medicine.

[27]  M. Wysocki,et al.  A pilot prospective study on closed loop controlled ventilation and oxygenation in ventilated children during the weaning phase , 2012, Critical Care.

[28]  Charles Natanson,et al.  Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. , 2002, American journal of respiratory and critical care medicine.

[29]  Robert L Chatburn,et al.  Closed-Loop Control of Mechanical Ventilation: Description and Classification of Targeting Schemes , 2011, Respiratory Care.

[30]  M. Lamy,et al.  The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. , 1994, American journal of respiratory and critical care medicine.

[31]  P. Papadakos,et al.  The open lung concept of mechanical ventilation: the role of recruitment and stabilization. , 2007, Critical care clinics.

[32]  M. Wysocki,et al.  Evaluation of fully automated ventilation: a randomized controlled study in post-cardiac surgery patients , 2013, Intensive Care Medicine.

[33]  P. Talke,et al.  Effect of Peripheral Vasoconstriction on Pulse Oximetry , 2006, Journal of Clinical Monitoring and Computing.

[34]  P. Pronovost,et al.  Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study , 2012, BMJ : British Medical Journal.

[35]  Paolo Pelosi,et al.  Evolution of mechanical ventilation in response to clinical research. , 2008, American journal of respiratory and critical care medicine.

[36]  F. Lellouche,et al.  Prophylactic protective ventilation: lower tidal volumes for all critically ill patients? , 2012, Intensive Care Medicine.

[37]  C. Carvalho,et al.  Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. , 1998, The New England journal of medicine.

[38]  L. Brochard,et al.  Influence of respiratory rate on gas trapping during low volume ventilation of patients with acute lung injury , 2002, Intensive Care Medicine.

[39]  J. Sinex.  Pulse oximetry: principles and limitations. , 1999, The American journal of emergency medicine.

[40]  Alan H. Morris,et al.  Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial , 1999, AMIA.

[41]  M. Weatherall,et al.  Systematic review of studies of the effect of hyperoxia on coronary blood flow. , 2009, American heart journal.