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Prospective Randomized Crossover Study of a New Closed-loop Control System versus Pressure Support during Weaning from Mechanical Ventilation.
MedLine Citation:
PMID:  23619172     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Intellivent is a new full closed-loop controlled ventilation that automatically adjusts both ventilation and oxygenation parameters. The authors compared gas exchange and breathing pattern variability of Intellivent and pressure support ventilation (PSV). METHODS:: In a prospective, randomized, single-blind design crossover study, 14 patients were ventilated during the weaning phase, with Intellivent or PSV, for two periods of 24 h in a randomized order. Arterial blood gases were obtained after 1, 8, 16, and 24 h with each mode. Ventilatory parameters were recorded continuously in a breath-by-breath basis during the two study periods. The primary endpoint was oxygenation, estimated by the calculation of the difference between the PaO2/FIO2 ratio obtained after 24 h of ventilation and the PaO2/FIO2 ratio obtained at baseline in each mode. The variability in the ventilatory parameters was also evaluated by the coefficient of variation (SD to mean ratio). RESULTS:: There were no adverse events or safety issues requiring premature interruption of both modes. The PaO2/FIO2 (mean ± SD) ratio improved significantly from 245±75 at baseline to 294±123 (P = 0.03) after 24h of Intellivent. The coefficient of variation of inspiratory pressure and positive end-expiratory pressure (median [interquartile range]) were significantly higher with Intellivent, 16 [11-21] and 15 [7-23]%, compared with 6 [5-7] and 7 [5-10]% in PSV. Inspiratory pressure, positive end-expiratory pressure, and FIO2 changes were adjusted significantly more often with Intellivent compared with PSV. CONCLUSIONS:: Compared with PSV, Intellivent during a 24-h period improved the PaO2/FIO2 ratio in parallel with more variability in the ventilatory support and more changes in ventilation settings.
Authors:
Noémie Clavieras; Marc Wysocki; Yannael Coisel; Fabrice Galia; Matthieu Conseil; Gerald Chanques; Boris Jung; Jean-Michel Arnal; Stefan Matecki; Nicolas Molinari; Samir Jaber
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-4-24
Journal Detail:
Title:  Anesthesiology     Volume:  -     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-4-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
* Research Fellow, Intensive Care Unit, Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Montpellier, France. † Associate Researcher, Research Center, Sainte-Justine University Hospital, Montréal, Canada. ‡ Associate Researcher Engineer, § Associate Professor of Anesthesiology and Critical Care, Intensive Care Unit, Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Université Montpellier 1, Montpellier, France. ‖ Staff Physician in Critical Care, Service de réanimation polyvalente, Hôpital Sainte Musse, Toulon, France. # Professor, Clinical Physiology Center, Arnaud de Villeneuve Teaching Hospital, Université Montpellier 1, Centre Hospitalier Universitaire Montpellier, Montpellier, France. ** Associate Professor of Statistic, Medical and Informatic Department, Lapeyronie University Hospital of Montpellier, Montpellier, France. †† Professor and Chairman, Intensive Care Unit, Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Université Montpellier 1, Centre Hospitalier Universitaire Montpellier, Montpellier, France.
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