PLoS ONE (Jan 2024)

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

  • 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

DOI
https://doi.org/10.1371/journal.pone.0307155
Journal volume & issue
Vol. 19, no. 7
p. e0307155

Abstract

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IntroductionMechanical 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 methodsInternational, 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.ResultsA 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 ConclusionsIn 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 registrationClinicaltrials.gov (study identifier NCT04827927), April 1, 2021.Url of trial registry recordhttps://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1.