Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725, chemin Sainte-Foy, Quebec City, QC G1V 4G5, Canada.
Intensive Care Med. 2013 Mar;39(3):463-71. doi: 10.1007/s00134-012-2799-2. Epub 2013 Jan 22.
Discrepancies between the demand and availability of clinicians to care for mechanically ventilated patients can be anticipated due to an aging population and to increasing severity of illness. The use of closed-loop ventilation provides a potential solution. The aim of the study was to evaluate the safety of a fully automated ventilator.
We conducted a randomized controlled trial comparing automated ventilation (AV) and protocolized ventilation (PV) in 60 ICU patients after cardiac surgery. In the PV group, tidal volume, respiratory rate, FiO(2) and positive end-expiratory pressure (PEEP) were set according to the local hospital protocol based on currently available guidelines. In the AV group, only sex, patient height and a maximum PEEP level of 10 cmH(2)O were set. The primary endpoint was the duration of ventilation within a "not acceptable" range of tidal volume. Zones of optimal, acceptable and not acceptable ventilation were based on several respiratory parameters and defined a priori.
The patients were assigned equally to each group, 30 to PV and 30 to AV. The percentage of time within the predefined zones of optimal, acceptable and not acceptable ventilation were 12 %, 81 %, and 7 % respectively with PV, and 89.5 %, 10 % and 0.5 % with AV (P < 0.001). There were 148 interventions required during PV compared to only 5 interventions with AV (P < 0.001).
Fully AV was safe in hemodynamically stable patients immediately following cardiac surgery. In addition to a reduction in the number of interventions, the AV system maintained patients within a predefined target range of optimal ventilation.
由于人口老龄化和疾病严重程度的增加，预计对机械通气患者进行护理的临床医生的需求和供应之间会出现差异。闭环通气的使用提供了一种潜在的解决方案。本研究的目的是评估全自动呼吸机的安全性。
我们进行了一项随机对照试验，比较了心脏手术后 60 例 ICU 患者的自动通气（AV）和程序化通气（PV）。在 PV 组中，根据当地医院根据现有指南制定的协议设置潮气量、呼吸频率、FiO(2)和呼气末正压（PEEP）。在 AV 组中，仅设置了性别、患者身高和最大 PEEP 水平为 10 cmH(2)O。主要终点是潮气量处于“不可接受”范围的通气时间。最佳、可接受和不可接受通气的区域是基于几个呼吸参数预先定义的。
患者平均分配到每组，PV 组 30 例，AV 组 30 例。PV 组预设的最佳、可接受和不可接受通气区的时间百分比分别为 12%、81%和 7%，而 AV 组分别为 89.5%、10%和 0.5%（P <0.001）。PV 组需要进行 148 次干预，而 AV 组仅需要进行 5 次干预（P <0.001）。
在心脏手术后血流动力学稳定的患者中，完全 AV 是安全的。除了减少干预次数外，AV 系统还可将患者维持在预设的最佳通气目标范围内。
