Smart Mode of Mechanical Lung Ventilation During Early Activation of Cardiosurgical Patients

Abstract

Purpose of the study: a comparative assessment of safety and quality of respiratory support carried out using the ASV mode vs. conventional protocol, in which ventilation parameters are set by an ICU physician during early postoperative period in cardiosurgical patients.Materials and methods. The modes of a respiratory support included automated ASV ventilation (40 patients) versus conventional ventilation (38 patients) managed by 8 ICU physicians were compared in a cohort of cardiosurgical patients in a randomized controlled study.The comparison included ventilation parameters, all efforts of physicians to adjust ventilator settings and time it took, duration of respiratory support in ICU, incidence of adverse events in the course of weaning, total time in ICU and hospital, postoperative complications and mortality.Results. There was no reliable difference in the duration of postoperative trachea intubation, which was equal to 267±76 minutes (the ASV group) and 271±80 minutes (the control group).The number of manual adjustments, which was 2 vs. 4 (P<0.00001), and the time spent by a clinical physician near a ventilator, which was 99±35 seconds vs. 166±70 seconds, were reliably lower in the ASV group (P=0.00001).The time between restoration of patient’s own respiratory activity and transfer to the assisted breathing mode was longer in the control group and amounted to 30 (0–90) min. while in the smart mode, the transfer took place immediately after restoration (P=0.004969).When ASV was used, the driving pressure was reliably lower during all phases of respiratory support: ΔP 7.2±1.6 vs. 9.3±2.1 cm H2O, (P=0.000001); there was no reliable difference in the tidal volume: 7.0 (6–8.5) (ASV) vs. 7 (6–10) ml/kg/ideal body mass (the control group).Conclusion. ASV represents a lung-protective ventilation that reduces physician’s time cost and medical staff efforts in ALV management without compromising patient’s safety and respiratory support quality.

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

“…With ASV, V T increased in cardiac surgery patients 17 and in ARDS patients 42 . ASV decreased V T in ARDS patients, 55 but did not affect V T in cardiac surgery 48,51 and COPD patients 21,47 . INTELLiVENT-ASV led to a lower V T 22,25,34 in cardiac surgery and unselected ICU patients, but V T increased 24 or was unaffected in general ICU patients 27,30,35 .…”

“…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 .…”

“…Only five studies were multicentre investigations 23,33,36,38,39 . Most studies were performed in critically ill patients with respiratory failure 15,16,18,22,24,26,27,29–31,33,35,36,39,41,46,47,54,62 ; twelve studies in patients after cardiac surgery 13,17,25,28,34,48–51,57 or general surgery, 20,23,43 four in difficult to wean patients, 19,32,38,40,56 four in COPD patients 14,21,44,45 and four in ARDS patients 37,42,53,55 . Nine studies tested SmartCare, 14,15,18,19,23,32,47,54,63 fourteen studies ASV, 13,17,21,42,43,45,46,48–53,55 eight studies INTELLiVENT–ASV, 22,24,25,27,28,30,34,35 eight studies NAVA, 20,36–41,62 six studies PAV+, 16,26,29,31,33,44 three studies Avea–CLiO 2 58–60 and one closed loop FiO 2 titrations during ASV 61 .…”

“…SmartCare, 18,19 ASV, 43,46,51 INTELLIVENT–ASV 25,27,28,30 and Avea–CLiO 2 were associated with fewer manual interventions at the ventilator 58–61 (Table 2, Fig. 3 and eTable S6, http://links.lww.com/EJA/A926).…”