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HAMILTON-T1. Intelligent transport ventilator

HAMILTON-T1

Our transport specialist! From neonates to adults

  • Fully featured ICU ventilator for transport
  • Approved for transportation on the ground, in the air, and on the water
  • Inside and outside of the hospital
HAMILTON-T1
HAMILTON-T1

Our transport specialist! From neonates to adults

  • Fully featured ICU ventilator for transport
  • Approved for patient transport on the ground, in the air, and on the water
  • Inside and outside of the hospital
HAMILTON-T1

Survival of the fittest! In the most demanding conditions

  • Temperatures from -15°C to +50°C
  • Ingress protection IP54
  • Maximum altitude of 7,620 meters
  • Rugged reinforced housing with impact protection and vibration proofing
  • Shock-resistant, antireflective display
HAMILTON-T1

Continuous ventilation therapy. Use the same mode and same settings as at the bedside

  • Volume-targeted and pressure-controlled ventilation modes
  • Adaptive ventilation with ASV® and INTELLiVENT®-ASV
  • Noninvasive ventilation
  • High flow nasal cannula therapy
HAMILTON-T1

Fiercely independent. No compressed air and battery powered

  • High-performance turbine
  • One integrated and one hot-swappable battery
  • Additional connector for low- pressure oxygen
HAMILTON-T1

Communication is key. For a better connection

Communication board options for:

  • SpO2 and/or CO2 sensors
  • Nurse Call
  • PDMS
  • HAMILTON-H900
  • RS232
HAMILTON-T1
HAMILTON-T1
CPR on a man

Code blue! Support during CPR

CPR ventilation adapts the ventilation settings if you have to perform CPR. It shows the main monitoring parameters and curves relevant to the situation, and supports your workflow with quick access to preconfigurable settings, adequate alarm and trigger adjustment, and a CPR-timer display.

Pie chart showing that 71% of air rescue organizations (in Germany, Austria, Switzerland, Italy, and Luxemburg) chose the HAMILTON‑T1 for their intensive care helicopter

The popular choice. For 71% of intensive care helicopters

As a transport ventilator for ambulances, helicopters, and more, the HAMILTON-T1 is a favorite for many rescue crews. According to the HOVER survey (Handover of ventilated Helicopter Emergency Services [HEMS] patients in the emergency roomA​) conducted online amongst air rescue organizations in Germany, Austria, Switzerland, Italy, and Luxemburg in 2019, 71% of those organizations chose the HAMILTON‑T1 for their intensive care helicopter (Hilbert-Carius, P., Struck, M.F., Hofer, V. et al. Nutzung des Hubschrauber-Respirators vom Landeplatz zum Zielort im Krankenhaus. Notfall Rettungsmed 23, 106–112 (2020)1​​).

Patient transport using a HAMILTON-T1

Don’t just meet standards. Exceed them

Ventilators suitable for pandemics and mass casualties must be versatile and meet various requirements. The HAMILTON-T1 meets or exceeds all requirements in the AARC Guidelines for Acquisition of Ventilators to Meet Demands for Pandemic Flu and Mass Casualty Incidents (www.aarc.org/wp-content/uploads/2020/03/ventilator-acquisition-guidelines.pdfB​).

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Explore the 3D model

Discover the HAMILTON-T1 from every angle and click on the hotspots to learn more.

For quick details

  • Standard
  • Option
  • Not available
Patient groups Adult/Ped, Neonatal
Dimensions (W x D x H) 320 x 220 x 270 mm (ventilation unit)
630 x 630 x 1380 mm (without handle)
630 x 630 x 1433 mm (with handle)
Weight 6.5 kg (14.3 lb)
18.5 kg (40.8 lb) with trolley
Monitor size and resolution 8.4 in (214 mm) diagonal
640 x 480 pixels
Detachable monitor
Battery operating time 4 h with one battery
8 h with two batteries
Hot-swappable battery
Air supply Integrated turbine
O2 connector DISS (CGA 1240) or NIST
Connectivity CO2/Nurse Call/COM1, CO2/SpO2/COM1, CO2/SpO2/Humidifier & COM1, USB port, RJ-45 Ethernet port
Loudness 43 dB in normal operation
Volume controlled, flow controlled
Volume targeted, adaptive pressure controlled
Intelligent ventilation ASV®, INTELLiVENT®-ASV® (option)
Noninvasive ventilation
High flow
Visualization of lung mechanics (Dynamic Lung)
Visualization of the patient’s ventilator dependence
Esophageal pressure measurement
Capnography
SpO2 monitoring
Recruitability assessment and lung recruitment (P/V Tool Pro)
Patient-ventilator synchronization (IntelliSync+)
CPR ventilation
Hamilton Connect Module
Hamilton Connect App
Remote connection to HAMILTON-H900 humidifier
Integrated IntelliCuff cuff pressure controller
Integrated pneumatic nebulizer
Integrated Aerogen nebulizer
Compatibility with Sedaconda ACD-S anesthetic delivery system
Call of duty; HAMILTON-T1 Military

The ventilator for armed forces.

Call of duty

Exposure to extreme conditions means a ventilator for armed forces has to meet very special requirements. That is where the HAMILTON-T1 Military takes over.

For your patients

Intelligent ventilation solutions at a glance

ASV® - Adaptive Support Ventilation®. For adaptation around the clock

The ventilation mode ASV continuously adjusts the respiratory rate, tidal volume, and inspiratory time breath by breath depending on the patient’s lung mechanics and effort - 24 hours a day, from intubation to extubation.

INTELLiVENT®-ASV. For bedside assistance

The intelligent ventilation mode INTELLiVENT-ASV continuously controls the ventilation and oxygenation of the patient.

It sets the minute ventilation, PEEP, and Oxygen based on the targets set by the clinician, and on physiologic input from the patient.

Integrated nebulizer. For additional treatments

The integrated pneumatic nebulizer is fully synchronized with the timing of inspiration and expiration.

An integrated, synchronized Aerogen nebulizer is available as an option (Not available in all marketsa​, Only available for HAMILTON-C6/G5/S1b​).

The delivery of a fine mist of drug aerosol particles helps you reverse bronchospasm, improve ventilation efficiency, and reduce hypercapnia (Dhand R. New frontiers in aerosol delivery during mechanical ventilation. Respir Care. 2004;49(6):666-677. 100​, Waldrep JC, Dhand R. Advanced nebulizer designs employing vibrating mesh/aperture plate technologies for aerosol generation. Curr Drug Deliv. 2008;5(2):114-119. doi:10.2174/156720108783954815101​).

High flow nasal cannula therapy. For O2 fanatics

High flow nasal cannula therapy (Also known as high flow oxygen therapy. This terminology can be used interchangeably with high flow nasal cannula therapyf​) is available as an option on all our ventilators. In just a few steps, you can change the interface and use the same device and breathing circuit to accommodate your patient’s therapy needs.

CPR ventilation. For lifesavers

CPR ventilation adapts the ventilator settings during rescucitation. It supports the CPR workflow with quick access to preconfigurable settings, adequate alarm and trigger adjustment, and CPR-timer display.

The main monitoring parameters and curves relevant to CPR ventilation are also displayed.

Hamilton Connect App. For smartphones

Built to meet the needs of modern healthcare providers, the Hamilton Connect App (The Hamilton Connect App is not intended to replace the real-time display of data on the ventilator. DO NOT USE the app to supplement or replace any part of the hospital's device monitoring. d​) gives you access to respiratory data on your mobile device. It also provides you with tools designed to facilitate and streamline your ventilation workflow.

All you need is a mobile device and a Hamilton Medical ventilator with the Hamilton Connect Module.

Volumetric capnography. For CO2ntrol freaks

Proximal flow and CO2 measurement enables our ventilators to perform up-to-date volumetric capnography, which provides an important basis for the assessment of ventilation quality and metabolic activity.

Vent Status panel. For those who are ready to wean

The Vent Status panel displays six parameters related to the patient’s ventilator dependence, including oxygenation, CO2 elimination, and patient activity.

A floating indicator moving up and down within each column shows the current value for a given parameter.

Remote humidifier access. For your convenience

The unique ventilator connectivity option enables you to operate the HAMILTON-H900 humidifier (The HAMILTON-H900 is not approved for use during transport.e​) directly from the ventilator's display. You can access all the controls, monitoring parameters, and alarms, and adjust them as needed.

The humidifier can also select the humidification mode automatically (invasive, noninvasive, or high flow) based on the selected ventilation mode.

Speaking valve. For chatterboxes

The Speak Valve option gives tracheostomized patients a voice, and allows them to swallow even while receiving respiratory support.

The ventilator's monitoring, triggering, and alarm management are adjusted for compatibility with speaking valves in pressure-controlled modes (PCV+, SPONT, PSIMV+).

Quick Wean. For the independent-minded

Quick Wean is a feature of the INTELLiVENT-ASV mode that provides continuous dynamic monitoring and control of patient conditions to evaluate the patient’s readiness for extubation.

Dynamic Lung panel. For visual people

The Dynamic Lung panel shows you a graphic real-time representation of the following important monitoring data:

  • Compliance and resistance
  • Patient triggering
  • SpO2
  • Pulse rate

Configurable loops and trends. For statisticians

The ventilator can display a dynamic loop based on a selected combination of monitored parameters. With the trend function, you can see trending information displayed for the monitoring parameters and time frame of your choice. 

The device continually stores the monitored parameters in its memory, even when in Standby.

Pulse oximetry. For SpO2 enthusiasts

The SpO2 option offers integrated noninvasive SpO2 measurement with the data displayed conveniently on your ventilator.

We also offer a comprehensive portfolio of SpO2 sensors.

High-performance noninvasive ventilation. For mask-wearers

The noninvasive ventilation modes deliver pressure-supported, flow-cycled spontaneous breaths (NIV and NIV-ST mode) and pressure-controlled, time-cycled mandatory breaths (NIV-ST).

Compared to ventilators using compressed air, our turbine-driven ventilators are capable of providing higher peak flow rates. This guarantees optimal performance even with large leaks.

nCPAP modes. For the little ones

With the nCPAP mode, the patient is supported with a continuous positive airway pressure. In our flow-controlled devices, the desired CPAP value is set via the respiratory gas flow. In order to compensate for any leakage that occurs, e.g. via the mouth or at the nose, the LeakAssist function can be activated. A predefined pressure can then be targeted with additional respiratory gas flow.

Intermountain LifeFlight Rega - Swiss Air Ambulance LifeLink III

Intermountain LifeFlight

Salt Lake City (UT), USA

Intermountain Life Flight is Utah’s leading air ambulance service. Since starting the program in 1978, we have stayed true to our commitment of providing exceptional patient care via helicopter, fixed wing, and ground ambulance.

Rega - Swiss Air Ambulance

Zürich, Schweiz

Swiss Air-Rescue, is a non-profit private foundation for air rescue in Switzerland, founded in 1952 by members of the Swiss Life Saving Society and based at Zurich Airport.

Read user report

LifeLink III

Bloomington (MN), USA

Life Link III operates nine helicopter bases located throughout Minnesota and Wisconsin. Helicopter and airplane services are available 24/7, providing on-scene emergency response and inter-facility transport.

For you

Breathing circuit set, coaxial

Preassembled. And ready to use

Our preassembled breathing circuit sets include the essential consumables to operate the ventilator, conveniently packaged in one single bag.

All our essential consumables are specially developed for Hamilton Medical ventilators with guaranteed manufacturer quality.

Automation; Hand turns knob button clockwise

Less knob-turning. More adaptations to your patient

To manage ventilation you usually have to set multiple parameters, such as pressure, volume, inspiratory and expiratory triggers, cuff pressure, and more. And each time your patient's condition changes, you have to make one or even several readjustments.

To simplify this process and reduce the knob-turning, we have created a range of solutions:

Adaptive Support Ventilation (ASV) is a ventilation mode that provides continuous adaptation of respiratory rate, tidal volume, and inspiratory time, depending on the patient’s lung mechanics and effort. ASV has been shown to shorten the duration of mechanical ventilation in various patient populations with fewer manual settings (Kirakli C, Naz I, Ediboglu O, Tatar D, Budak A, Tellioglu E. A randomized controlled trial comparing the ventilation duration between adaptive support ventilation and pressure assist/control ventilation in medical patients in the ICU. Chest. 2015;147(6):1503-1509. doi:10.1378/chest.14-25992​, Tam MK, Wong WT, Gomersall CD, et al. A randomized controlled trial of 2 protocols for weaning cardiac surgical patients receiving adaptive support ventilation. J Crit Care. 2016;33:163-168. doi:10.1016/j.jcrc.2016.01.0183​, Zhu F, Gomersall CD, Ng SK, Underwood MJ, Lee A. A randomized controlled trial of adaptive support ventilation mode to wean patients after fast-track cardiac valvular surgery. Anesthesiology. 2015;122(4):832-840. doi:10.1097/ALN.00000000000005894​).

Our intelligent ventilation mode INTELLiVENT-ASV promotes you from knob-turner to supervisor, reduces the number of manual interactions with the ventilator (Arnal JM, Garnero A, Novotni D, et al. Closed loop ventilation mode in Intensive Care Unit: a randomized controlled clinical trial comparing the numbers of manual ventilator setting changes. Minerva Anestesiol. 2018;84(1):58-67. doi:10.23736/S0375-9393.17.11963-25​, Bialais E, Wittebole X, Vignaux L, et al. Closed-loop ventilation mode (IntelliVent®-ASV) in intensive care unit: a randomized trial. Minerva Anestesiol. 2016;82(6):657-668. 6​, Fot EV, Izotova NN, Yudina AS, Smetkin AA, Kuzkov VV, Kirov MY. Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting. Front Med (Lausanne). 2017;4:31. Published 2017 Mar 21. doi:10.3389/fmed.2017.000317​), and ensures individualized lung-protective ventilation for your patient (Bialais E, Wittebole X, Vignaux L, et al. Closed-loop ventilation mode (IntelliVent®-ASV) in intensive care unit: a randomized trial. Minerva Anestesiol. 2016;82(6):657-668. 6​, Fot EV, Izotova NN, Yudina AS, Smetkin AA, Kuzkov VV, Kirov MY. Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting. Front Med (Lausanne). 2017;4:31. Published 2017 Mar 21. doi:10.3389/fmed.2017.000317​, Arnal JM, Saoli M, Garnero A. Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients. Heart Lung. 2020;49(4):427-434. doi:10.1016/j.hrtlng.2019.11.0018​), from intubation to extubation.

Conventional solutions for cuff pressure management require you to monitor and adjust cuff pressure by hand.

IntelliCuff secures your patient’s airway (Chenelle CT, Oto J, Sulemanji D, Fisher DF, Kacmarek RM. Evaluation of an automated endotracheal tube cuff controller during simulated mechanical ventilation. Respir Care. 2015;60(2):183-190. doi:10.4187/respcare.033879​) by continuously measuring and automatically maintaining the set cuff pressure for adult, pediatric, and neonatal patients.

Professional interacting with touch-screen

Help is near! On-screen troubleshooting

Whenever there is a problem, the ventilator alerts you using the alarm lamp, sound, and message bar.

The on-screen help offers you suggestions on how to resolve the alarm.

Hamilton Connect App

Connect with me. No strings attached

Built to meet the needs of modern healthcare providers, the Hamilton Connect App gives you access to respiratory data. It provides you with a solution designed to facilitate and streamline your ventilation workflow. All you need is a mobile device and a Hamilton Medical ventilator with the Hamilton Connect Module (The Hamilton Connect App is not intended to replace the real-time display of data on the ventilator. DO NOT USE the app to supplement or replace any part of the hospital's device monitoring. C​).

Professionals looking into Hamilton Medical e-learnings

Get the hang of it! Learning paths and educational content

Our online Academy offers easy-to-follow learning paths to familiarize you with Hamilton Medical products and technologies as quickly as possible.

Dr. Ralf Huth Trisha Degoyer Thomas Burren

Customer voices

We use the HAMILTON-T1 for intrahospital transport and transfers to other hospitals. This ensures that the patient receives the same quality of ventilation during transport as at the bedside.

Dr. Ralf Huth

Senior Physician Interdisciplinary Pediatric ICU
Center for Pediatrics and Adolescent Medicine, Mainz, Germany

Customer voices

To be able to use nCPAP with the HAMILTON‑T1 is a huge advantage for us. We no longer have to intubate certain babies just for transport.

Trisha Degoyer

Life Flight Neonatal RN
Intermountain Life Flight, Salt Lake City (UT), USA

Customer voices

The HAMILTON‑T1 transport ventilator is very small and compact, but still has all the features of a conventional ICU ventilator.

Thomas Burren

Chief Nurse Rega Jet
Rega - Swiss Air Rescue, Zurich, Switzerland

For the future

Illustration of a compass pointing towards the future

Constant evolution. Expanding your ventilator’s capabilities

We are constantly working on further evolving our products. New features are added and existing features improved to ensure you always have access to the latest ventilation technology over your ventilator’s lifetime.

How we keep your ventilator up-to-date
Hamilton ventilation family Hamilton ventilation family

Know one, know them all. A universal user interface

Whether it is in the ICU, in the MRI suite, or during transport, the user interface of all Hamilton Medical ventilators works in the same way.

Our Ventilation Cockpit integrates complex data into intuitive visualizations.

For the complete solution

Fully integrated accessories

We develop our accessories for the highest possible patient safety and ease of use in mind. Whenever possible, we integrate them with our ventilators to simplify operation of the complete ventilator system.

Our consumables

All Hamilton Medical Originals are designed for optimal performance with Hamilton Medical ventilators. To ensure maximum user satisfaction and patient safety, we strive for the highest quality and safety standards.

References

  1. 1. Hilbert-Carius, P., Struck, M.F., Hofer, V. et al. Nutzung des Hubschrauber-Respirators vom Landeplatz zum Zielort im Krankenhaus. Notfall Rettungsmed 23, 106–112 (2020).
  2. 2. Kirakli C, Naz I, Ediboglu O, Tatar D, Budak A, Tellioglu E. A randomized controlled trial comparing the ventilation duration between adaptive support ventilation and pressure assist/control ventilation in medical patients in the ICU. Chest. 2015;147(6):1503-1509. doi:10.1378/chest.14-2599
  3. 3. Tam MK, Wong WT, Gomersall CD, et al. A randomized controlled trial of 2 protocols for weaning cardiac surgical patients receiving adaptive support ventilation. J Crit Care. 2016;33:163-168. doi:10.1016/j.jcrc.2016.01.018
  4. 4. Zhu F, Gomersall CD, Ng SK, Underwood MJ, Lee A. A randomized controlled trial of adaptive support ventilation mode to wean patients after fast-track cardiac valvular surgery. Anesthesiology. 2015;122(4):832-840. doi:10.1097/ALN.0000000000000589
  5. 5. Arnal JM, Garnero A, Novotni D, et al. Closed loop ventilation mode in Intensive Care Unit: a randomized controlled clinical trial comparing the numbers of manual ventilator setting changes. Minerva Anestesiol. 2018;84(1):58-67. doi:10.23736/S0375-9393.17.11963-2
  6. 6. Bialais E, Wittebole X, Vignaux L, et al. Closed-loop ventilation mode (IntelliVent®-ASV) in intensive care unit: a randomized trial. Minerva Anestesiol. 2016;82(6):657-668.

 

  1. 7. Fot EV, Izotova NN, Yudina AS, Smetkin AA, Kuzkov VV, Kirov MY. Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting. Front Med (Lausanne). 2017;4:31. Published 2017 Mar 21. doi:10.3389/fmed.2017.00031
  2. 8. Arnal JM, Saoli M, Garnero A. Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients. Heart Lung. 2020;49(4):427-434. doi:10.1016/j.hrtlng.2019.11.001
  3. 9. Chenelle CT, Oto J, Sulemanji D, Fisher DF, Kacmarek RM. Evaluation of an automated endotracheal tube cuff controller during simulated mechanical ventilation. Respir Care. 2015;60(2):183-190. doi:10.4187/respcare.03387
  4. 100. Dhand R. New frontiers in aerosol delivery during mechanical ventilation. Respir Care. 2004;49(6):666-677.
  5. 101. Waldrep JC, Dhand R. Advanced nebulizer designs employing vibrating mesh/aperture plate technologies for aerosol generation. Curr Drug Deliv. 2008;5(2):114-119. doi:10.2174/156720108783954815

Footnotes

  • A. Handover of ventilated Helicopter Emergency Services [HEMS] patients in the emergency room
  • B. https://www.aarc.org/wp-content/uploads/2020/03/ventilator-acquisition-issue-paper.pdf
  • a. Not available in all markets
  • b. Only available for HAMILTON-C6/G5/S1

 

  • d. The Hamilton Connect App is not intended to replace the real-time display of data on the ventilator. DO NOT USE the app to supplement or replace any part of the hospital's device monitoring
  • e. The HAMILTON-H900 is not approved for use during transport
  • f. Also known as high flow oxygen therapy. This terminology can be used interchangeably with high flow nasal cannula therapy.

Nutzung des Hubschrauber-Respirators vom Landeplatz zum Zielort im Krankenhaus Sekundäranalyse der HOVER-Umfrage zu beatmeten Notfallpatienten in der Luftrettung

Hilbert-Carius, P., Struck, M.F., Hofer, V. et al. Nutzung des Hubschrauber-Respirators vom Landeplatz zum Zielort im Krankenhaus. Notfall Rettungsmed 23, 106–112 (2020).

A randomized controlled trial comparing the ventilation duration between adaptive support ventilation and pressure assist/control ventilation in medical patients in the ICU.

Kirakli C, Naz I, Ediboglu O, Tatar D, Budak A, Tellioglu E. A randomized controlled trial comparing the ventilation duration between adaptive support ventilation and pressure assist/control ventilation in medical patients in the ICU. Chest. 2015;147(6):1503-1509. doi:10.1378/chest.14-2599



BACKGROUND

Adaptive support ventilation (ASV) is a closed loop mode of mechanical ventilation (MV) that provides a target minute ventilation by automatically adapting inspiratory pressure and respiratory rate with the minimum work of breathing on the part of the patient. The aim of this study was to determine the effect of ASV on total MV duration when compared with pressure assist/control ventilation.

METHODS

Adult medical patients intubated and mechanically ventilated for > 24 h in a medical ICU were randomized to either ASV or pressure assist/control ventilation. Sedation and medical treatment were standardized for each group. Primary outcome was the total MV duration. Secondary outcomes were the weaning duration, number of manual settings of the ventilator, and weaning success rates.

RESULTS

Two hundred twenty-nine patients were included. Median MV duration until weaning, weaning duration, and total MV duration were significantly shorter in the ASV group (67 [43-94] h vs 92 [61-165] h, P = .003; 2 [2-2] h vs 2 [2-80] h, P = .001; and 4 [2-6] days vs 4 [3-9] days, P = .016, respectively). Patients in the ASV group required fewer total number of manual settings on the ventilator to reach the desired pH and Paco2 levels (2 [1-2] vs 3 [2-5], P < .001). The number of patients extubated successfully on the first attempt was significantly higher in the ASV group (P = .001). Weaning success and mortality at day 28 were comparable between the two groups.

CONCLUSIONS

In medical patients in the ICU, ASV may shorten the duration of weaning and total MV duration with a fewer number of manual ventilator settings.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT01472302; URL: www.clinicaltrials.gov.

A randomized controlled trial of 2 protocols for weaning cardiac surgical patients receiving adaptive support ventilation.

Tam MK, Wong WT, Gomersall CD, et al. A randomized controlled trial of 2 protocols for weaning cardiac surgical patients receiving adaptive support ventilation. J Crit Care. 2016;33:163-168. doi:10.1016/j.jcrc.2016.01.018



PURPOSE

This study aims to compare the effectiveness of weaning with adaptive support ventilation (ASV) incorporating progressively reduced or constant target minute ventilation in the protocol in postoperative care after cardiac surgery.

MATERIAL AND METHODS

A randomized controlled unblinded study of 52 patients after elective coronary artery bypass surgery was carried out to determine whether a protocol incorporating a decremental target minute ventilation (DTMV) results in more rapid weaning of patients ventilated in ASV mode compared to a protocol incorporating a constant target minute ventilation.

RESULTS

Median duration of mechanical ventilation (145 vs 309 minutes; P = .001) and intubation (225 vs 423 minutes; P = .005) were significantly shorter in the DTMV group. There was no difference in adverse effects (42% vs 46%) or mortality (0% vs 0%) between the 2 groups.

CONCLUSIONS

Use of a DTMV protocol for postoperative ventilation of cardiac surgical patients in ASV mode results in a shorter duration of ventilation and intubation without evidence of increased risk of adverse effects.

A randomized controlled trial of adaptive support ventilation mode to wean patients after fast-track cardiac valvular surgery.

Zhu F, Gomersall CD, Ng SK, Underwood MJ, Lee A. A randomized controlled trial of adaptive support ventilation mode to wean patients after fast-track cardiac valvular surgery. Anesthesiology. 2015;122(4):832-840. doi:10.1097/ALN.0000000000000589



BACKGROUND

Adaptive support ventilation can speed weaning after coronary artery surgery compared with protocolized weaning using other modes. There are no data to support this mode of weaning after cardiac valvular surgery. Furthermore, control group weaning times have been long, suggesting that the results may reflect control group protocols that delay weaning rather than a real advantage of adaptive support ventilation.

METHODS

Randomized (computer-generated sequence and sealed opaque envelopes), parallel-arm, unblinded trial of adaptive support ventilation versus physician-directed weaning after adult fast-track cardiac valvular surgery. The primary outcome was duration of mechanical ventilation. Patients aged 18 to 80 yr without significant renal, liver, or lung disease or severe impairment of left ventricular function undergoing uncomplicated elective valve surgery were eligible. Care was standardized, except postoperative ventilation. In the adaptive support ventilation group, target minute ventilation and inspired oxygen concentration were adjusted according to blood gases. A spontaneous breathing trial was carried out when the total inspiratory pressure of 15 cm H2O or less with positive end-expiratory pressure of 5 cm H2O. In the control group, the duty physician made all ventilatory decisions.

RESULTS

Median duration of ventilation was statistically significantly shorter (P = 0.013) in the adaptive support ventilation group (205 [141 to 295] min, n = 30) than that in controls (342 [214 to 491] min, n = 31). Manual ventilator changes and alarms were less common in the adaptive support ventilation group, and arterial blood gas estimations were more common.

CONCLUSION

Adaptive support ventilation reduces ventilation time by more than 2 h in patients who have undergone fast-track cardiac valvular surgery while reducing the number of manual ventilator changes and alarms.

Closed loop ventilation mode in Intensive Care Unit: a randomized controlled clinical trial comparing the numbers of manual ventilator setting changes.

Arnal JM, Garnero A, Novotni D, et al. Closed loop ventilation mode in Intensive Care Unit: a randomized controlled clinical trial comparing the numbers of manual ventilator setting changes. Minerva Anestesiol. 2018;84(1):58-67. doi:10.23736/S0375-9393.17.11963-2



BACKGROUND

There is an equipoise regarding closed-loop ventilation modes and the ability to reduce workload for providers. On one hand some settings are managed by the ventilator but on another hand the automatic mode introduces new settings for the user.

METHODS

This randomized controlled trial compared the number of manual ventilator setting changes between a full closed loop ventilation and oxygenation mode (INTELLiVENT-ASV®) and conventional ventilation modes (volume assist control and pressure support) in Intensive Care Unit (ICU) patients. The secondary endpoints were to compare the number of arterial blood gas analysis, the sedation dose and the user acceptance. Sixty subjects with an expected duration of mechanical ventilation of at least 48 hours were randomized to be ventilated using INTELLiVENT-ASV® or conventional modes with a protocolized weaning. All manual ventilator setting changes were recorded continuously from inclusion to successful extubation or death. Arterial blood gases were performed upon decision of the clinician in charge. User acceptance score was assessed for nurses and physicians once daily using a Likert Scale.

RESULTS

The number of manual ventilator setting changes per 24 h-period per subject was lower in INTELLiVENT-ASV® as compared to conventional ventilation group (5 [4-7] versus 10 [7-17]) manuals settings per subject per day [P<0.001]). The number of arterial blood gas analysis and the sedation doses were not significantly different between the groups. Nurses and physicians reported that INTELLiVENT-ASV® was significantly easier to use as compared to conventional ventilation (P<0.001 for nurses and P<0.01 for physicians).

CONCLUSIONS

For mechanically ventilated ICU patients, INTELLiVENT-ASV® significantly reduces the number of manual ventilator setting changes with the same number of arterial blood gas analysis and sedation dose, and is easier to use for the caregivers as compared to conventional ventilation modes.

Closed-loop ventilation mode (IntelliVent®-ASV) in intensive care unit: a randomized trial.

Bialais E, Wittebole X, Vignaux L, et al. Closed-loop ventilation mode (IntelliVent®-ASV) in intensive care unit: a randomized trial. Minerva Anestesiol. 2016;82(6):657-668.



BACKGROUND

Closed-loop modes automatically adjust ventilation settings, delivering individualized ventilation over short periods of time. The objective of this randomized controlled trial was to compare safety, efficacy and workload for the health care team between IntelliVent®-ASV and conventional modes over a 48-hour period.

METHODS

ICU patients admitted with an expected duration of mechanical ventilation of more than 48 hours were randomized to IntelliVent®-ASV or conventional ventilation modes. All ventilation parameters were recorded breath-by-breath. The number of manual adjustments assesses workload for the healthcare team. Safety and efficacy were assessed by calculating the time spent within previously defined ranges of non-optimal and optimal ventilation, respectively.

RESULTS

Eighty patients were analyzed. The median values of ventilation parameters over 48 hours were similar in both groups except for PEEP (7[4] cmH2O versus 6[3] cmH2O with IntelliVent®-ASV and conventional ventilation, respectively, P=0.028) and PETCO2 (36±7 mmHg with IntelliVent®-ASV versus 40±8 mmHg with conventional ventilation, P=0.041). Safety was similar between IntelliVent®-ASV and conventional ventilation for all parameters except for PMAX, which was more often non-optimal with IntelliVent®-ASV (P=0.001). Efficacy was comparable between the 2 ventilation strategies, except for SpO2 and VT, which were more often optimal with IntelliVent®-ASV (P=0.005, P=0.016, respectively). IntelliVent®-ASV required less manual adjustments than conventional ventilation (P<0.001) for a higher total number of adjustments (P<0.001). The coefficient of variation over 48 hours was larger with IntelliVent®-ASV in regard of maximum pressure, inspiratory pressure (PINSP), and PEEP as compared to conventional ventilation.

CONCLUSIONS

IntelliVent®-ASV required less manual intervention and delivered more variable PEEP and PINSP, while delivering ventilation safe and effective ventilation in terms of VT, RR, SpO2 and PETCO2.

Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting.

Fot EV, Izotova NN, Yudina AS, Smetkin AA, Kuzkov VV, Kirov MY. Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting. Front Med (Lausanne). 2017;4:31. Published 2017 Mar 21. doi:10.3389/fmed.2017.00031



BACKGROUND

The discontinuation of mechanical ventilation after coronary surgery may prolong and significantly increase the load on intensive care unit personnel. We hypothesized that automated mode using INTELLiVENT-ASV can decrease duration of postoperative mechanical ventilation, reduce workload on medical staff, and provide safe ventilation after off-pump coronary artery bypass grafting (OPCAB). The primary endpoint of our study was to assess the duration of postoperative mechanical ventilation during different modes of weaning from respiratory support (RS) after OPCAB. The secondary endpoint was to assess safety of the automated weaning mode and the number of manual interventions to the ventilator settings during the weaning process in comparison with the protocolized weaning mode.

MATERIALS AND METHODS

Forty adult patients undergoing elective OPCAB were enrolled into a prospective single-center study. Patients were randomized into two groups: automated weaning (n = 20) using INTELLiVENT-ASV mode with quick-wean option; and protocolized weaning (n = 20), using conventional synchronized intermittent mandatory ventilation (SIMV) + pressure support (PS) mode. We assessed the duration of postoperative ventilation, incidence and duration of unacceptable RS, and the load on medical staff. We also performed the retrospective analysis of 102 patients (standard weaning) who were weaned from ventilator with SIMV + PS mode based on physician's experience without prearranged algorithm.

RESULTS AND DISCUSSION

Realization of the automated weaning protocol required change in respiratory settings in 2 patients vs. 7 (5-9) adjustments per patient in the protocolized weaning group. Both incidence and duration of unacceptable RS were reduced significantly by means of the automated weaning approach. The FiO2 during spontaneous breathing trials was significantly lower in the automated weaning group: 30 (30-35) vs. 40 (40-45) % in the protocolized weaning group (p < 0.01). The average time until tracheal extubation did not differ in the automated weaning and the protocolized weaning groups: 193 (115-309) and 197 (158-253) min, respectively, but increased to 290 (210-411) min in the standard weaning group.

CONCLUSION

The automated weaning system after off-pump coronary surgery might provide postoperative ventilation in a more protective way, reduces the workload on medical staff, and does not prolong the duration of weaning from ventilator. The use of automated or protocolized weaning can reduce the duration of postoperative mechanical ventilation in comparison with non-protocolized weaning based on the physician's decision.

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

Arnal JM, Saoli M, Garnero A. Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients. Heart Lung. 2020;49(4):427-434. doi:10.1016/j.hrtlng.2019.11.001



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.

Evaluation of an automated endotracheal tube cuff controller during simulated mechanical ventilation.

Chenelle CT, Oto J, Sulemanji D, Fisher DF, Kacmarek RM. Evaluation of an automated endotracheal tube cuff controller during simulated mechanical ventilation. Respir Care. 2015;60(2):183-190. doi:10.4187/respcare.03387



BACKGROUND

Maintaining endotracheal tube cuff pressure within a narrow range is an important factor in patient care. The goal of this study was to evaluate the IntelliCuff against the manual technique for maintaining cuff pressure during simulated mechanical ventilation with and without movement.

METHODS

The IntelliCuff was compared to the manual technique of a manometer and syringe. Two independent studies were performed during mechanical ventilation: part 1, a 2-h trial incorporating continuous mannikin head movement; and part 2, an 8-h trial using a stationary trachea model. We set cuff pressure to 25 cm H2O, PEEP to 10 cm H2O, and peak inspiratory pressures to 20, 30, and 40 cm H2O. Clinical importance was defined as both statistically significant (P<.05) and clinically significant (pressure change [Δ]>10%).

RESULTS

In part 1, the change in cuff pressure from before to after ventilation was clinically important for the manual technique (P<.001, Δ=-39.6%) but not for the IntelliCuff (P=.02, Δ=3.5%). In part 2, the change in cuff pressure from before to after ventilation was clinically important for the manual technique (P=.004, Δ=-14.39%) but not for the IntelliCuff (P=.20, Δ=5.65%).

CONCLUSIONS

There was a clinically important drop in manually set cuff pressure during simulated mechanical ventilation in a stationary model and an even larger drop with movement, but this was significantly reduced by the IntelliCuff in both scenarios. Additionally, we observed that cuff pressure varied directly with inspiratory airway pressure for both techniques, leading to elevated average cuff pressures.

New frontiers in aerosol delivery during mechanical ventilation.

Dhand R. New frontiers in aerosol delivery during mechanical ventilation. Respir Care. 2004;49(6):666-677.

The scientific basis for inhalation therapy in mechanically-ventilated patients is now firmly established. A variety of new devices that deliver drugs to the lung with high efficiency could be employed for drug delivery during mechanical ventilation. Encapsulation of drugs within liposomes could increase the amount of drug delivered, prolong the effect of a dose, and minimize adverse effects. With improved inhalation devices and surfactant formulations, inhaled surfactant could be employed for several indications in mechanically-ventilated patients. Research is unraveling the causes of some disorders that have been poorly understood, and our improved understanding of the causal mechanisms of various respiratory disorders will provide new applications for inhaled therapies.

Advanced nebulizer designs employing vibrating mesh/aperture plate technologies for aerosol generation.

Waldrep JC, Dhand R. Advanced nebulizer designs employing vibrating mesh/aperture plate technologies for aerosol generation. Curr Drug Deliv. 2008;5(2):114-119. doi:10.2174/156720108783954815

Recent technological advances and improved nebulizer designs have overcome many limitations of jet nebulizers. Newer devices employ a vibrating mesh or aperture plate (VM/AP) for the generation of therapeutic aerosols with consistent, increased efficiency, predominant aerosol fine particle fractions, low residuals, and the ability to nebulize even microliter volumes. These enhancements are achieved through several different design features and include improvements that promote patient compliance, such as compact design, portability, shorter treatment durations, and quiet operation. Current VM/AP devices in clinical use are the Omron MicroAir, the Nektar Aeroneb, and the Pari eFlow. However, some devices are only approved for use with specific medications. Development of "smart nebulizers" such as the Respironics I-neb couple VM technologies with coordinated delivery and optimized inhalation patterns to enhance inhaled drug delivery of specialized, expensive formulations. Ongoing development of advanced aerosol technologies should improve clinical outcomes and continue to expand therapeutic options as newer inhaled drugs become available.