Automated vs. conventional ventilation in the ICU: a randomized controlled crossover trial comparing blood oxygen saturation during daily nursing procedures (I-NURSING)

Abstract

Background: Hypoxia is common during daily nursing procedures (DNPs) routinely performed on mechanically ventilated patients. The impact of automated ventilation on the incidence and severity of blood oxygen desaturation during DNPs remains unknown. Methods: A prospective randomized controlled crossover trial was carried out in a French intensive care unit to compare blood oxygen pulse saturation (SpO 2) during DNPs performed on patients mechanically ventilated in automated and conventional ventilation modes (AV and CV, respectively). All patients with FiO 2 ≤ 60% and without prone positioning or neuromuscular blocking agents were included. Patients underwent two DNPs on the same day using AV (INTELLiVENT-ASV®) and CV (volume control, biphasic positive airway pressure, or pressure support ventilation) in a randomized order. The primary outcome was the percentage of time spent with SpO 2 in the acceptable range of 90-95% during the DNP. Results: Of the 265 included patients, 93% had been admitted for a medical pathology, the majority for acute respiratory failure (52%). There was no difference between the two periods in terms of DNP duration, sedation requirements, or ventilation parameters, but patients had more spontaneous breaths and lower peak airway pressures during the AV period (p < 0.001). The percentage of time spent with SpO 2 in the acceptable range during DNPs was longer in the AV period than in the CV period (48 ± 37 vs. 43 ± 37, percentage of DNP period; p = 0.03). After adjustment, AV was associated with a higher number of DNPs carried out with SpO 2 in the acceptable range (odds ratio, 1.82; 95% CI, 1.28 to 2.6; p = 0.001) and a lower incidence of blood oxygen desaturation ≤ 85% (adjusted odds ratio, 0.50; 95% CI, 0.30 to 0.85; p = 0.01).

Effects of closed loop ventilation on ventilator settings, patient outcomes and ICU staff workloads – a systematic review

“…The search identified a total of 801 studies; after removal of duplicates and screening for eligibility, 45 studies in adult 13–57 and six studies in paediatric patients 58–63 were considered for this analysis (Fig. 1 and eTable S1, http://links.lww.com/EJA/A926).…”

“…1 and eTable S1, http://links.lww.com/EJA/A926). Thirty-five studies had a parallel randomised design 13–19,21,23,25–31,33,34,36,38–40,43–57,62,63 ; 12 had a crossover randomised design 20,22,24,32,35,37,41,42,58–61 . Only five studies were multicentre investigations 23,33,36,38,39 .…”

Dexmedetomidine improves lung compliance in patients undergoing lateral decubitus position of shoulder arthroscopy: A randomized controlled trial

“…The surgical position of patients after anesthesia may have a particular impact on ventilation. [ 12 ] Some surgical positions may restrict thoracic or diaphragm movement or increase lung blood volume due to liquid gravity, resulting in decreased thoracic and lung compliance, tidal volume, and lung capacity. Shoulder arthroscopic surgery is mainly performed in lateral decubitus, and ventilation is significantly reduced in patients with a low-prone head, lateral decubitus, and lumbar pad.…”

Closed-loop ventilation

“…In some situations in the ICU, such as during daily nursing procedures, it can be challenging to maintain adequate oxygenation and patients are at risk of having low SpO2 that goes unrecognized. A randomized crossover study in a large number of ICU patients showed that INTELLiVENT-ASV was able to reduce the incidence and severity of blood oxygen desaturation during daily nursing procedures as compared to nonautomated ventilation [33 ▪ ].…”