Lung-protective ventilation in COVID-19 patients

05.07.2021

A new study from the University Hospital Zurich compared the use of INTELLiVENT®-ASV® with conventional modes in COVID-19 ARDS during the first wave in 2020.

A total of 40 critically ill patients were allocated to either the closed-loop or conventional (BiPAP and Pressure Support) group and data was collected for 1,048,630 minutes or 728 days of cumulative mechanical ventilation (1). The primary objective was to measure the overall percentage of lung-protective ventilation in each group, based on recommendations for tidal volume, driving pressure, peak pressure, SpO2, and mechanical power. For both the initial period of seven days and the total duration of mechanical ventilation, INTELLiVENT-ASV kept patients within the lung-protective range for a significantly greater amount of time than the conventional modes. In addition, the number of manual adjustments to settings was lower – an advantage that is particularly relevant in the context of a pandemic.

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At the same time, results from a cohort of 1,503 COVID-19 patients during the first wave in Sao Paolo, Brazil, show a direct association between the mechanical ventilation strategy and mortality (2). Of the 984 patients ventilated invasively during the first 24 hours of ICU stay, 82% of those received protective ventilation (tidal volume < 8 ml/kg PBW and plateau pressure < 30 cmH2O). The investigators found that lung-protective ventilation, adjusted for PF ratio, compliance, PEEP and arterial pH, was independently associated with survival at 28 days.

Another study from the Netherlands designed to compare ventilation parameters between ICU devices and an anesthesia machine used off-label for ICU ventilation demonstrated how frequently closed-loop ventilation was used for COVID-19 patients. In a cohort of 32 patients treated in March and April 2020, the investigators used INTELLiVENT-ASV 79% of the time for the first four full days of ventilation (3).

  1. Wendel Garcia PD, Hofmaenner DA, et al. Closed-Loop Versus Conventional Mechanical Ventilation in COVID-19 ARDS. J Intensive Care Med. 2021 Jun 8. 
  2. Ferreira JC, Ho YL, Besen BAMP, et al.; EPICCoV Study Group. Protective ventilation and outcomes of critically ill patients with COVID-19: a cohort study. Ann Intensive Care. 2021 Jun 7;11(1):92.
  3. Dijkman WM, van Acht NMC, van Akkeren JP, et al. Comparing Ventilation Parameters for COVID-19 Patients Using Both Long-Term ICU and Anesthetic Ventilators in Times of Shortage. J Intensive Care Med. 2021 Jun 17:8850666211024911.Epub ahead of print. 

Date of Printing: 06.08.2021
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