Comparative analysis of fully automated vs. conventional ventilation in postoperative cardiac surgery patients: Impact on alarms, interventions, and nurse acceptance

doi:10.1016/j.iccn.2025.103963

Randomized Controlled Trial

. 2025 Aug:89:103963.

doi: 10.1016/j.iccn.2025.103963. Epub 2025 Feb 11.

Comparative analysis of fully automated vs. conventional ventilation in postoperative cardiac surgery patients: Impact on alarms, interventions, and nurse acceptance

Lisan M A A van Haren¹, Daphne L J Nabben², Carla Kloeze³, Michiel A C Dekker⁴, Tineke J C De Vries⁵, Laura A Buiteman-Kruizinga⁶, Ary Serpa Neto⁷, Tobias van Leijsen⁸, Frederique Paulus⁸, David M P van Meenen⁸, Leon Montenij², Erik H M Korsten², Alexander J G H Bindels⁴, Arthur R Bouwman⁹, Marcus J Schultz¹⁰, Ashley J R De Bie Dekker¹¹

Affiliations

¹ Department of Medical Physics, Catharina Hospital, Eindhoven, Netherlands. Electronic address: lisan.v.haren@catharinaziekenhuis.nl.
² Intensive Care Department, Catharina Hospital, Eindhoven, Netherlands; Anaesthesiology Department, Catharina Hospital, Eindhoven, Netherlands; Electrical Engineering, Signal Processing, Eindhoven University of Technology, Eindhoven, Netherlands.
³ Department of Medical Physics, Catharina Hospital, Eindhoven, Netherlands.
⁴ Intensive Care Department, Catharina Hospital, Eindhoven, Netherlands.
⁵ Department of Medical Physics, Catharina Hospital, Eindhoven, Netherlands; Electrical Engineering, Signal Processing, Eindhoven University of Technology, Eindhoven, Netherlands.
⁶ Department of Intensive Care, Reinier de Graaf Hospital, Delft, Netherlands; Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, Amsterdam, Netherlands.
⁷ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁸ Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, Amsterdam, Netherlands.
⁹ Anaesthesiology Department, Catharina Hospital, Eindhoven, Netherlands; Electrical Engineering, Signal Processing, Eindhoven University of Technology, Eindhoven, Netherlands.
¹⁰ Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, Amsterdam, Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Division of Cardiac, Thoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anaesthesiology, General Intensive Care and Pain Medicine, Medical University Vienna, Vienna, Austria.
¹¹ Intensive Care Department, Catharina Hospital, Eindhoven, Netherlands; Electrical Engineering, Signal Processing, Eindhoven University of Technology, Eindhoven, Netherlands.

PMID: 39938276
DOI: 10.1016/j.iccn.2025.103963

Randomized Controlled Trial

Comparative analysis of fully automated vs. conventional ventilation in postoperative cardiac surgery patients: Impact on alarms, interventions, and nurse acceptance

Lisan M A A van Haren et al. Intensive Crit Care Nurs. 2025 Aug.

. 2025 Aug:89:103963.

doi: 10.1016/j.iccn.2025.103963. Epub 2025 Feb 11.

Authors

Affiliations

¹ Department of Medical Physics, Catharina Hospital, Eindhoven, Netherlands. Electronic address: lisan.v.haren@catharinaziekenhuis.nl.
² Intensive Care Department, Catharina Hospital, Eindhoven, Netherlands; Anaesthesiology Department, Catharina Hospital, Eindhoven, Netherlands; Electrical Engineering, Signal Processing, Eindhoven University of Technology, Eindhoven, Netherlands.
³ Department of Medical Physics, Catharina Hospital, Eindhoven, Netherlands.
⁴ Intensive Care Department, Catharina Hospital, Eindhoven, Netherlands.
⁵ Department of Medical Physics, Catharina Hospital, Eindhoven, Netherlands; Electrical Engineering, Signal Processing, Eindhoven University of Technology, Eindhoven, Netherlands.
⁶ Department of Intensive Care, Reinier de Graaf Hospital, Delft, Netherlands; Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, Amsterdam, Netherlands.
⁷ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁸ Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, Amsterdam, Netherlands.
⁹ Anaesthesiology Department, Catharina Hospital, Eindhoven, Netherlands; Electrical Engineering, Signal Processing, Eindhoven University of Technology, Eindhoven, Netherlands.
¹⁰ Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, Amsterdam, Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Division of Cardiac, Thoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anaesthesiology, General Intensive Care and Pain Medicine, Medical University Vienna, Vienna, Austria.
¹¹ Intensive Care Department, Catharina Hospital, Eindhoven, Netherlands; Electrical Engineering, Signal Processing, Eindhoven University of Technology, Eindhoven, Netherlands.

PMID: 39938276
DOI: 10.1016/j.iccn.2025.103963

Abstract

Objectives: To compare the number of alarms, interventions and nurses' acceptance of automated ventilation with INTELLiVENT-ASV versus conventional ventilation strategy in patients receiving postoperative ventilation after cardiac surgery.

Methods: This preplanned secondary analysis of the 'POSITiVE' randomized clinical trial compared INTELLiVENT-ASV (automated ventilation) with conventional ventilation in postoperative cardiac surgery patients. The number of critical alarms and manual ventilator interventions were compared during the first three hours of ventilation or until extubation. Nurses' acceptance was assessed using a Technology Acceptance Model 2-based questionnaire and a user acceptance score from 1 to 10.

Results: POSITiVE randomized 220 patients (109 to automated and 111 to conventional ventilation). The average number of critical alarms per monitoring hour was similar between the automated and conventional group (5.6 vs 5.7; p = 0.823). The automated group required fewer manual interventions per monitoring hour for both ventilation control (0.7 vs 1.9; p < 0.001) and alarm management (2.0 vs 2.8; p < 0.001). The automated ventilation mode scored higher for perceived usefulness (2.6 vs 2.1; p < 0.001) and user acceptance (8.0 vs 7.0; p < 0.001), but similar for perceived ease of use.

Conclusions: Automated ventilation for postoperative cardiac surgery patients had similar alarm frequencies as conventional ventilation, but reduced the number of interventions and showed higher nurses' acceptance, indicating its potential to optimize patient care and reduce nurses' workload.

Implications for clinical practice: Our findings suggest that automated ventilation modes like INTELLiVENT-ASV can reduce the frequency of manual interventions and improve nurses' acceptance, which may help alleviate nurses' workload for postoperative cardiac surgery patients.

Keywords: Alarms; Closed-loop ventilation; INTELLiVENT-ASV; Intensive care unit; Interventions; Mechanical ventilation; Nurse; Nurse workload; Postoperative cardiac surgery; User acceptance.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: L. Buiteman-Kruizinga reports a relationship with HAMILTON MEDICAL that includes: speaking and lecture fees and travel reimbursement. A. Bouwman reports a relationship with CSL Behring that includes: travel reimbursement. A. Bouwman reports a relationship with Philips that includes: consulting or advisory. E. Korsten reports a relationship with Philips that includes: consulting or advisory. M. Schultz reports a relationship with HAMILTON MEDICAL that includes: employment and funding grants. M. Schultz reports a relationship with Drager Medical that includes: funding grants. M. Schultz reports a relationship with NovaLung/Xenios that includes: funding grants. A. De Bie Dekker reports a relationship with A&I journal that includes: board membership. A. De Bie Dekker reports a relationship with Impuls-2 project that includes: funding grants. A. De Bie Dekker reports a relationship with HAMILTON MEDICAL that includes: speaking and lecture fees and travel reimbursement. A. De Bie Dekker reports a relationship with Philips that includes: consulting or advisory. Has patent pending to. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Comparative analysis of fully automated vs. conventional ventilation in postoperative cardiac surgery patients: Impact on alarms, interventions, and nurse acceptance

Affiliations

Comparative analysis of fully automated vs. conventional ventilation in postoperative cardiac surgery patients: Impact on alarms, interventions, and nurse acceptance

Authors

Affiliations

Abstract

Conflict of interest statement

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