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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Article info
Publication history
Published online: November 14, 2019
Accepted:
November 1,
2019
Received in revised form:
October 31,
2019
Received:
June 18,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
