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. 2021 Nov 19;10(22):5409.
doi: 10.3390/jcm10225409.

Effect of INTELLiVENT-ASV versus Conventional Ventilation on Ventilation Intensity in Patients with COVID-19 ARDS-An Observational Study

Laura A Buiteman-Kruizinga  1   2 , Hassan E Mkadmi  3 , Ary Serpa Neto  2   4   5 , Matthijs D Kruizinga  6 , Michela Botta  2 , Marcus J Schultz  2   7   8   9 , Frederique Paulus  2   10 , Pim L J van der Heiden  1
Affiliations

Effect of INTELLiVENT-ASV versus Conventional Ventilation on Ventilation Intensity in Patients with COVID-19 ARDS-An Observational Study

Laura A Buiteman-Kruizinga et al. J Clin Med. .

Abstract

Driving pressure (ΔP) and mechanical power (MP) are associated with outcomes in critically ill patients, irrespective of the presence of Acute Respiratory Distress Syndrome (ARDS). INTELLiVENT-ASV, a fully automated ventilatory mode, controls the settings that affect ΔP and MP. This study compared the intensity of ventilation (ΔP and MP) with INTELLiVENT-ASV versus conventional ventilation in a cohort of COVID-19 ARDS patients in two intensive care units in the Netherlands. The coprimary endpoints were ΔP and MP before and after converting from conventional ventilation to INTELLiVENT-ASV. Compared to conventional ventilation, INTELLiVENT-ASV delivered ventilation with a lower ΔP and less MP. With conventional ventilation, ΔP was 13 cmH2O, and MP was 21.5 and 24.8 J/min, whereas with INTELLiVENT-ASV, ΔP was 11 and 10 cmH2O (mean difference -2 cm H2O (95 %CI -2.5 to -1.2 cm H2O), p < 0.001) and MP was 18.8 and 17.5 J/min (mean difference -7.3 J/Min (95% CI -8.8 to -5.8 J/min), p < 0.001). Conversion from conventional ventilation to INTELLiVENT-ASV resulted in a lower intensity of ventilation. These findings may favor the use of INTELLiVENT-ASV in COVID-19 ARDS patients, but future studies remain needed to see if the reduction in the intensity of ventilation translates into clinical benefits.

Keywords: ARDS; COVID-19; INTELLiVENT-ASV; automated ventilation; closed-loop ventilation; driving pressure; intensity of ventilation; mechanical power.

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Conflict of interest statement

Marcus J. Schultz attended a workshop organized by Hamilton in 2018. The expenses for lodging were covered for the invited experts, and participants from abroad had their travel expenses reimbursed. Additionally, speakers received a speaker’s fee of CHF 800. Laura A. Buiteman-Kruizinga visited Hamilton Medical in September 2021 to take part in an advisory board and to give lectures. The expenses for lodging were covered, she had her travel expenses reimbursed and received an advisory- and speaker’s fee of € 1500. The other authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Study profile. Consort diagram showing flow of patients.
Figure 2
Figure 2
Cumulative frequency distribution of (a) ΔP and (b) MP. The plots show ΔP and MP 2 and 1 h before the conversion and 1 and 2 h after the conversion from conventional ventilation to INTELLiVENT-ASV. Vertical dotted lines represent the median at the last hour before the conversion, and horizontal dotted lines show the respective proportion of patients reaching each cutoff.
Figure 3
Figure 3
Plot of the relation between VT and ΔP with conventional ventilation at (a) 2 and 1 h before conversion to INTELLiVENT-ASV, and at (b) 1 and 2 h after conversion.
Figure 4
Figure 4
Scatterplot of individual changes in (a) tidal volume (ml/kg PBW) and (b) driving pressure (cm H2O) when the patients were switched from conventional ventilation, at 1 h before conversion, to INTELLiVENT-ASV (VT, INTELLiVENT-ASV-VT, INTELLiVENT-ASV; and ΔP, INTELLiVENT-ASV-ΔP, conventional) 2 h after conversion. Continuous line; regression lines. Each patient was characterized by a single data point. A negative value for VT or ΔP means that the conversion to INTELLiVENT-ASV resulted in a lower VT or ΔP, and a positive value means that VT or ΔP increased after the conversion.
Figure 5
Figure 5
Cumulative frequency distribution of (a) tidal volume, (b) respiratory rate, (c) maximum airway pressure, (d) PEEP, (e) etCO2 and (f) SpO2. The plots show the ventilation variables 2 and 1 h before the conversion and 1 and 2 h after the conversion from conventional ventilation to INTELLiVENT-ASV. Vertical dotted lines represent the median at the last hour before the conversion, and horizontal dotted lines show the respective proportion of patients reaching each cutoff.
Figure 5
Figure 5
Cumulative frequency distribution of (a) tidal volume, (b) respiratory rate, (c) maximum airway pressure, (d) PEEP, (e) etCO2 and (f) SpO2. The plots show the ventilation variables 2 and 1 h before the conversion and 1 and 2 h after the conversion from conventional ventilation to INTELLiVENT-ASV. Vertical dotted lines represent the median at the last hour before the conversion, and horizontal dotted lines show the respective proportion of patients reaching each cutoff.
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