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Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial.
oleh: Laura A Buiteman-Kruizinga, Ary Serpa Neto, Michela Botta, Stephanie S List, Ben H de Boer, Patricia van Velzen, Philipp Karl Bühler, Pedro D Wendel Garcia, Marcus J Schultz, Pim L J van der Heiden, Frederique Paulus, INTELLiPOWER–investigators
Format: | Article |
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Diterbitkan: | Public Library of Science (PLoS) 2024-01-01 |
Deskripsi
<h4>Introduction</h4>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.<h4>Materials and methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.<h4>Study registration</h4>Clinicaltrials.gov (study identifier NCT04827927), April 1, 2021.<h4>Url of trial registry record</h4>https://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1.