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Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients

  • Jean-Michel Arnal
    Correspondence
    Corresponding author to Dr. Jean-Michel Arnal, Service de Réanimation Polyvalente, Hôpital Sainte Musse, 54 avenue Henri Sainte Claire Deville, 83056, Toulon, France.
    Affiliations
    Service de Réanimation Polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon, France

    Department of Medical Research, Hamilton Medical AG, via Crusch 8, 7402 Bonaduz, Switzerland
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  • Mathieu Saoli
    Affiliations
    Service de Réanimation Polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon, France
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  • Aude Garnero
    Affiliations
    Service de Réanimation Polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon, France
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Published:November 14, 2019DOI:https://doi.org/10.1016/j.hrtlng.2019.11.001

      Highlights

      • Ventilator induced lung injuries are due to excessive stress, strain, or atelectrauma.
      • Driving pressure assesses the strain applied to the lungs during mechanical ventilation.
      • Mechanical power represents the energy load transferred from the ventilator to the respiratory system.
      • INTELLiVENT-ASV selected driving pressure and mechanical power considered in safe ranges for lung protection.

      Abstract

      Background

      Driving pressure (ΔP) and mechanical power (MP) are predictors of the risk of ventilation- induced lung injuries (VILI) in mechanically ventilated patients. INTELLiVENT-ASV® is a closed-loop ventilation mode that automatically adjusts respiratory rate and tidal volume, according to the patient's respiratory mechanics.

      Objectives

      This prospective observational study investigated ΔP and MP (and also transpulmonary ΔP (ΔPL) and MP (MPL) for a subgroup of patients) delivered by INTELLiVENT-ASV.

      Methods

      Adult patients admitted to the ICU were included if they were sedated and met the criteria for a single lung condition (normal lungs, COPD, or ARDS). INTELLiVENT-ASV was used with default target settings. If PEEP was above 16 cmH2O, the recruitment strategy used transpulmonary pressure as a reference, and ΔPL and MPL were computed. Measurements were made once for each patient.

      Results

      Of the 255 patients included, 98 patients were classified as normal-lungs, 28 as COPD, and 129 as ARDS patients. The median ΔP was 8 (7 − 10), 10 (8 − 12), and 9 (8 − 11) cmH2O for normal-lungs, COPD, and ARDS patients, respectively. The median MP was 9.1 (4.9 – 13.5), 11.8 (8.6 – 16.5), and 8.8 (5.6 – 13.8) J/min for normal-lungs, COPD, and ARDS patients, respectively. For the 19 patients managed with transpulmonary pressure ΔPL was 6 (4 − 7) cmH2O and MPL was 3.6 (3.1 – 4.4) J/min.

      Conclusions

      In this short term observation study, INTELLiVENT-ASV selected ΔP and MP considered in safe ranges for lung protection. In a subgroup of ARDS patients, the combination of a recruitment strategy and INTELLiVENT-ASV resulted in an apparently safe ΔPL and MPL.

      Keywords

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