A closed-loop ventilation mode that targets the lowest work and force of breathing reduces the transpulmonary driving pressure in patients with moderate-to-severe ARDS

Journal article

Abstract Introduction The driving pressure (Δ P ) has an independent association with outcome in patients with acute respiratory distress syndrome (ARDS). INTELLiVENT-Adaptive Support Ventilation (ASV) is a closed-loop mode of ventilation that targets the lowest work and force of breathing. Aim To compare transpulmonary and respiratory system Δ P between closed-loop ventilation and conventional pressure controlled ventilation in patients with moderate-to-severe ARDS. Methods Single-center randomized cross-over clinical trial in patients in the early phase of ARDS. Patients were randomly assigned to start with a 4-h period of closed-loop ventilation or conventional ventilation, after which the alternate ventilation mode was selected. The primary outcome was the transpulmonary Δ P ; secondary outcomes included respiratory system Δ P , and other key parameters of ventilation. Results Thirteen patients were included, and all had fully analyzable data sets. Compared to conventional ventilation, with closed-loop ventilation the median transpulmonary Δ P with was lower (7.0 [5.0–10.0] vs. 10.0 [8.0–11.0] cmH 2 O, mean difference − 2.5 [95% CI − 2.6 to − 2.1] cmH 2 O; P = 0.0001). Inspiratory transpulmonary pressure and the respiratory rate were also lower. Tidal volume, however, was higher with closed-loop ventilation, but stayed below generally accepted safety cutoffs in the majority of patients. Conclusions In this small physiological study, when compared to conventional pressure controlled ventilation INTELLiVENT-ASV reduced the transpulmonary Δ P in patients in the early phase of moderate-to-severe ARDS. This closed-loop ventilation mode also led to a lower inspiratory transpulmonary pressure and a lower respiratory rate, thereby reducing the intensity of ventilation. Trial registration Clinicaltrials.gov, NCT03211494, July 7, 2017. https://clinicaltrials.gov/ct2/show/NCT03211494?term=airdrop&draw=2&rank=1 .

Authors: Buiteman-Kruizinga, LA; van Meenen, DMP; Bos, LDJ; van der Heiden, PLJ; Paulus, F

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: SpringerOpen
• Journal: Intensive Care Medicine Experimental
• Volume: 11
• Issue: 1
• Pages: 42
• Publication date: 2023-07-13
• DOI: 10.1186/s40635-023-00527-1
• EISSN: 2197-425X
• ISSN: 2197-425X
• Language: English
• Keywords: Work of breathing; Advanced Life Support; Mechanically Ventilated Patients; Noninvasive Ventilation; Transpulmonary pressure; Plateau pressure; Positive End-Expiratory Pressure