自动通气与常规通气对通气机械功的影响：一项随机交叉临床试验。

Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial.

机构信息

Department of Intensive Care, Reinier de Graaf Hospital, Delft, the Netherlands.

Department of Intensive Care, Amsterdam University Medical Centers 'Location AMC', Amsterdam, the Netherlands.

出版信息

PLoS One. 2024 Jul 30;19(7):e0307155. doi: 10.1371/journal.pone.0307155. eCollection 2024.

DOI:10.1371/journal.pone.0307155

PMID:39078857

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11288413/

Abstract

INTRODUCTION

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.

MATERIALS AND METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

STUDY REGISTRATION

Clinicaltrials.gov (study identifier NCT04827927), April 1, 2021.

URL OF TRIAL REGISTRY RECORD

https://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1.

摘要

简介

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。

材料和方法

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。

结果

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）。