Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial

• Published in: PloS one Vol. 19; no. 7; p. e0307155
• Main Authors: Buiteman-Kruizinga, Laura A, Serpa Neto, Ary, Botta, Michela, List, Stephanie S, de Boer, Ben H, van Velzen, Patricia, Bühler, Philipp Karl, Wendel Garcia, Pedro D, Schultz, Marcus J, van der Heiden, Pim L J, Paulus, Frederique
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30.07.2024; Public Library of Science (PLoS)
• Subjects: Adaptive algorithms; Adult; Aged; Algorithms; Automation; Biology and Life Sciences; Clinical trials; Critical Illness - therapy; Cross-Over Studies; Engineering and Technology; Female; Hospitals; Humans; Male; Mean; Medicine and Health Sciences; Middle Aged; Ostomy; Parameters; Patients; People and Places; Physical Sciences; Product development; Rankings; Respiration, Artificial - methods; Respiratory system; Statistical analysis; Subgroups; Ventilation; Ventilators; Ventilators, Mechanical; Switzerland; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0307155

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. 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. 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). 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. Clinicaltrials.gov (study identifier NCT04827927), April 1, 2021. https://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1.