Botta Michela, van Meenen David M P, van Leijsen Tobias D, Rogmans Jitske R, List Stephanie S, van der Heiden Pim L J, Horn Janneke, Paulus Frederique, Schultz Marcus J, Buiteman-Kruizinga Laura A
Department of Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Department of Intensive Care, Dijklander Hospital, 1624 NP Hoorn, The Netherlands.
J Clin Med. 2024 Dec 25;14(1):41. doi: 10.3390/jcm14010041.
: Attaining adequate oxygenation in critically ill patients undergoing invasive ventilation necessitates intense monitoring through pulse oximetry (SpO) and frequent manual adjustments of ventilator settings like the fraction of inspired oxygen (FiO) and the level of positive end-expiratory pressure (PEEP). Our aim was to compare the quality of oxygenation with the use of automated ventilation provided by INTELLiVENT-Adaptive Support Ventilation (ASV) vs. ventilation that is not automated, i.e., conventional pressure-controlled or pressure support ventilation. : A substudy within a randomized crossover clinical trial in critically ill patients under invasive ventilation. The primary endpoint was the percentage of breaths in an optimal oxygenation zone, defined by predetermined levels of SpO, FiO, and PEEP. Secondary endpoints were the percentage of breaths in acceptable or critical oxygenation zones, the percentage of time spent in optimal, acceptable, and critical oxygenation zones, the number of manual interventions at the ventilator, and the number and duration of ventilator alarms related to oxygenation. : Of the 96 patients included in the parent study, 53 were eligible for this current subanalysis. Among them, 31 patients were randomized to start with automated ventilation, while 22 patients began with conventional ventilation. No significant differences were found in the percentage of breaths within the optimal zone between the two ventilation modes (median percentage of breaths during automated ventilation 19.4 [0.1-99.9]% vs. 25.3 [0.0-100.0]%; = 0.963). Similarly, there were no differences in the percentage of breaths within the acceptable and critical zones, nor in the time spent in the three predefined oxygenation zones. Although the number of manual interventions was lower with automated ventilation, the number and duration of ventilator alarms were fewer with conventional ventilation. : The quality of oxygenation with automated ventilation is not different from that with conventional ventilation. However, while automated ventilation comes with fewer manual interventions at the ventilator, it also comes with more ventilator alarms.
对于接受有创通气的重症患者，要实现充分氧合，需要通过脉搏血氧饱和度测定法（SpO）进行密切监测，并频繁手动调整呼吸机设置，如吸入氧分数（FiO）和呼气末正压（PEEP）水平。我们的目的是比较使用INTELLiVENT-自适应支持通气（ASV）提供的自动通气与非自动通气（即传统压力控制通气或压力支持通气）时的氧合质量。：一项针对接受有创通气的重症患者的随机交叉临床试验中的子研究。主要终点是处于最佳氧合区的呼吸百分比，该区域由预先确定的SpO、FiO和PEEP水平定义。次要终点是处于可接受或临界氧合区的呼吸百分比、在最佳、可接受和临界氧合区所花费的时间百分比、呼吸机的手动干预次数以及与氧合相关的呼吸机警报次数和持续时间。：在纳入母研究的96例患者中，53例符合本次子分析的条件。其中，31例患者被随机分配先接受自动通气，而22例患者先接受传统通气。两种通气模式在最佳区域内的呼吸百分比方面未发现显著差异（自动通气期间呼吸的中位数百分比为19.4[0.1 - 99.9]%，而传统通气为25.3[0.0 - 100.0]%；P = 0.963）。同样，在可接受和临界区域内的呼吸百分比以及在三个预定义氧合区所花费的时间方面也没有差异。虽然自动通气时的手动干预次数较少，但传统通气时的呼吸机警报次数和持续时间较少。：自动通气的氧合质量与传统通气无异。然而，自动通气虽然在呼吸机上的手动干预较少，但呼吸机警报较多。
