Department of Intensive Care, Reinier de Graaf Hospital, Delft, the Netherlands.
Department of Intensive Care, Amsterdam University Medical Centers 'Location AMC', Amsterdam, the Netherlands.
PLoS One. 2024 Jul 30;19(7):e0307155. doi: 10.1371/journal.pone.0307155. eCollection 2024.
Mechanical 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.
International, 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.
A 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 < 0.01), and not in active patients (14.6 [11.0-20.3] vs 14.1 [10.1-21.3] J/min; mean difference 0.81 (95%-CI -2.13 to 0.49) J/min; P = 0.23).
In 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.
Clinicaltrials.gov (study identifier NCT04827927), April 1, 2021.
https://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1.
通气的机械功率是反映呼吸机向呼吸系统传递能量的综合参数，与结局相关。INTELLiVENT-自适应支持通气是一种自动通气模式，根据针对低呼吸功和力的算法来改变呼吸机设置。本研究旨在比较 INTELLiVENT-自适应支持通气的自动通气和常规通气之间的机械功率。
这是一项在预计需要机械通气>24 小时的危重症患者中进行的国际、多中心、随机交叉临床试验。患者随机分为 3 小时的自动通气期或常规通气期，之后选择交替通气模式。主要结局为被动和主动患者的机械功率；次要结局包括影响机械功率的关键呼吸机设置和通气参数。
共纳入 96 例患者。自动通气和常规通气的机械功率中位数无差异（15.8[11.5-21.0]与 16.1[10.9-22.6]J/min；平均差值-0.44（95%CI-1.17 至 0.29）J/min；P=0.24）。亚组分析显示，在被动患者中，自动通气的机械功率较低，为 16.9[12.5-22.1]与 19.0[14.1-25.0]J/min；平均差值-1.76（95%CI-2.47 至-10.34）J/min；P<0.01），而在主动患者中则无差异（14.6[11.0-20.3]与 14.1[10.1-21.3]J/min；平均差值 0.81（95%CI-2.13 至 0.49）J/min；P=0.23）。
在本队列中，未选择接受有创机械通气的危重症患者中，通过 INTELLiVENT-自适应支持通气的自动通气并未降低机械功率。仅在被动患者中观察到机械功率降低。
Clinicaltrials.gov（研究标识符 NCT04827927），2021 年 4 月 1 日。
https://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1.
