Low tidal volume ventilation is associated with mortality in COVID-19 patients—Insights from the PRoVENT-COVID study

Nijbroek, Sunny G. L. H.; Hol, Liselotte; Ivanov, D.; Schultz, Marcus J.; Paulus, Frederique; Neto, Ary Serpa

doi:10.1016/j.jcrc.2022.154047

Cited by 9 publications

(8 citation statements)

References 46 publications

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“…In a subsequent secondary analysis of the national PRo-VENT cohort, patients receiving LTVV at <6 mL/kg ideal body weight (IBW) were compared with those that did not. 57 The 28-day mortality was significantly lower in the LTVV group 23.1 vs. 31.7% and were more likely to have received prone positioning (61.9 vs. 55.5%), NMB n (57.1 vs. 43.8%) and were slightly younger (median 62.5 vs. 66 years) but otherwise the two groups were very well matched. The results are somewhat surprising since the median TV in the two groups were astonishingly close (5.65 mL/kg IBW for LTVV and 6.7 mL/kg IBW for non-LTVV), as were driving pressure and mechanical power all of which would be considered well within the protective ventilation arm of any other ARDS ventilation trial.…”

Section: Mechanical Ventilationmentioning

confidence: 82%

Techniques for Oxygenation and Ventilation in Coronavirus Disease 2019

Richards

Smith

2023

Semin Respir Crit Care Med

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This paper discusses mechanisms of hypoxemia and interventions to oxygenate critically ill patients with COVID-19 which range from nasal cannula to noninvasive and mechanical ventilation. Noninvasive ventilation includes continuous positive airway pressure ventilation (CPAP) and high-flow nasal cannula (HFNC) with or without proning. The evidence for each of these modalities is discussed and thereafter, when to transition to mechanical ventilation (MV). Various techniques of MV, again with and without proning, and rescue strategies which would include extra corporeal membrane oxygenation (ECMO) when it is available and permissive hypoxemia where it is not, are discussed.

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Section: Mechanical Ventilationmentioning

confidence: 82%

Techniques for Oxygenation and Ventilation in Coronavirus Disease 2019

Richards

Smith

2023

Semin Respir Crit Care Med

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“…With COVID‐19 ARDS, the lungs are severely injured because of a complex and heterogeneous syndrome, with sometimes pulmonary embolism. Like with any other form of ARDS, lung‐protective ventilation with low ΔP and less MP 6–9 can limit lung injury and improve outcomes 10–12 …”

Section: Introductionmentioning

confidence: 99%

“…Like with any other form of ARDS, lung-protective ventilation with low ΔP and less MP [6][7][8][9] can limit lung injury and improve outcomes. [10][11][12] Early in the first wave of the national outbreak, we realized we needed to use this closed-loop ventilation mode because, not only did we want to use safe ventilation, but we also wanted to aim for a low workload for the nursing staff. During the first year of the pandemic, we learned how to use INTELLiVENT-ASV.…”

mentioning

confidence: 99%

Closed‐loop ventilation in COVID‐19 patients with acute hypoxemic respiratory failure—A case series

Buiteman‐Kruizinga

Heiden

Paulus

et al. 2023

Nursing in Critical Care

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BackgroundINTELLiVENT‐adaptive support ventilation (ASV) is an automated closed‐loop mode of invasive ventilation for use in critically ill patients. INTELLiVENT‐ASV automatically adjusts, without the intervention of the caregiver, ventilator settings to achieve the lowest work and force of breathing.AimsThe aim of this case series is to describe the specific adjustments of INTELLiVENT‐ASV in patients with acute hypoxemic respiratory failure, who were intubated for invasive ventilation.Study designWe describe three patients with severe acute respiratory distress syndrome (ARDS) because of COVID‐19 who received invasive ventilation in our intensive care unit (ICU) in the first year of the COVID‐19 pandemic.ResultsINTELLiVENT‐ASV could be used successfully, but only after certain adjustments in the settings of the ventilator. Specifically, the high oxygen targets that are automatically chosen by INTELLiVENT‐ASV when the lung condition ‘ARDS’ is ticked had to be lowered, and the titration ranges for positive end expiratory pressure (PEEP) and inspired oxygen fraction (FiO2) had to be narrowed.ConclusionThe challenges taught us how to adjust the ventilator settings so that INTELLiVENT‐ASV could be used in successive COVID‐19 ARDS patients, and we experienced the benefits of this closed‐loop ventilation in clinical practice.Relevance to clinical practiceINTELLiVENT‐ASV is attractive to use in clinical practice. It is safe and effective in providing lung‐protective ventilation. A closely observing user always remains needed. INTELLiVENT‐ASV has a strong potential to reduce the workload associated with ventilation because of the automated adjustments.

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“…On the ventilator, there is also a tidal volume parameter that functions to supply mixed air to the patient and respiratory rate [4], which is the frequency of breath given to the patient, and the humidifier functions to regulate the temperature of the air given to the patient [5]. A tidal volume or pressure that is too large can cause hyperventilation, barotrauma, and hemodynamic instability [6], [7]. Tidal volume is the maximum volume of the lungs or the amount of air that goes into and out of breath [8]- [11].…”

Section: Introductionmentioning

confidence: 99%

Design of Ventilator with Gas Mixing, Tidal Volume, and Humidifier Parameters

Fajrin¹,

Susanto²,

Kristianto³

et al. 2022

Journal of Robotics and Control

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On the ventilator, there are several important parameters, including gas mixing, which functions to mix oxygen with free air, the tidal volume serves to supply mixed air to the patient, respiratory rate is the frequency of breath given to the patient, and the humidifier functions to regulate the temperature of the air given to the patient. In this research, the author intends to design a ventilator device which uses a working system to open and close the valve to distribute air to the patient. This tool uses several sensors: oxygen sensor KE-25F3, flow sensor yf-s201, pressure sensor MPX 5700, and temperature sensor DS 12B20. The tidal volume (VT) has 3 setting values: 700 ml, 500 ml, and 300 ml. The test is carried out by opening and closing the valve. The respiratory rate has 2 settings of 15 and 20 breaths/minute. In addition, the humidifier has 3 setting modes 32, 35, and 40o C. From the test results, the highest error was obtained in the 300 ml tidal volume test, which was 7.20% and in the respiratory rate test, the highest error value was 0%. The test results with the oxygen concentration parameter obtained the largest error value of 0.1% at 100% oxygen concentration. In testing the temperature and humidity parameters, the largest average error was 2.40% at 40o C setting. So, it can be concluded that the tool is feasible to use because of the level of small error and still within the standard calibration tolerance of 15%.

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Low tidal volume ventilation is associated with mortality in COVID-19 patients—Insights from the PRoVENT-COVID study

Cited by 9 publications

References 46 publications

Techniques for Oxygenation and Ventilation in Coronavirus Disease 2019

Techniques for Oxygenation and Ventilation in Coronavirus Disease 2019

Closed‐loop ventilation in COVID‐19 patients with acute hypoxemic respiratory failure—A case series

Design of Ventilator with Gas Mixing, Tidal Volume, and Humidifier Parameters

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