A recent study on cardiac surgery patients shows that fully automated ventilation is more likely to be lung-protective than conventional ventilation delivered by experienced healthcare professionals.
The single-center, randomized controlled trial conducted in the Netherlands compared the use of INTELLiVENT-ASV with conventional ventilation in 220 hemodynamically stable patients after elective cardiac surgery. The aim was to determine whether INTELLiVENT-ASV was more effective in delivering lung-protective ventilation than a team of well-trained and experienced ICU nurses and doctors using conventional ventilation modes. The primary outcome was the amount of time patients spent exposed to predefined optimal, acceptable, and critical (injurious) ventilatory parameters in the first three postoperative hours.
Amongst the secondary outcomes were severe hypoxemia (SpO2 <85%) and the time taken to resume spontaneous breathing. Results of the study showed that patients randomized to automated ventilation:
- Spent almost one third more time in the optimal zone
- Spent less time in the critical zone
- Were less likely to suffer from severe hypoxemia
- Resumed spontaneous breathing more quickly
The authors highlight the importance of these results in two respects. Firstly, it is extremely costly for hospitals to ensure enough well-trained staff are available to provide optimal ventilation to patients, especially with an aging population and increasing severity of illness. Secondly, a pandemic like the current one puts a huge strain on critical care resources, as there are not enough trained staff to provide optimal ventilation for the huge numbers of critically ill patients. The authors conclude that “fully automated ventilation modes could serve as a potential solution at minimal extra cost, whilst offering the potential to reduce the number of interactions with the ventilator by bedside caregivers.”
De Bie AJR, Neto AS, van Meenen DM, et al. Fully automated postoperative ventilation in cardiac surgery patients: a randomised clinical trial [published online ahead of print, 2020 Jul 29]. Br J Anaesth. 2020;S0007-0912(20)30497-9.
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