Lower mechanical power with INTELLiVENT®-ASV® in COVID-19 ARDS

25.11.2021

A recent study from the Netherlands in COVID-19 ARDS found that INTELLiVENT-ASV resulted in lower driving pressure and mechanical power than conventional ventilation.

In this substudy of the ‘PRactice of VENTilation in COVID‐19’ (PRoVENT–COVID) study, a cohort of 51 COVID-19 ARDS patients was ventilated first in conventional modes and subsequently switched to INTELLiVENT-ASV (1). Measurements were taken at 2 and 1 hours prior to converting, and then at 1 and 2 hours after.

The median values for driving pressure decreased from 13 cmH2O at both timepoints before the conversion down to 11 and 10 cmH2O at the first and second hour after the conversion, respectively. Mechanical power dropped from 21.5 and 24.8 J/min down to 18.8 and 17.5 J/min. All differences were statistically significant. In addition, the median RR, Pmax, minute volume, and FiO2 also decreased, and the respiratory system compliance improved during INTELLiVENT-ASV. Tidal volume increased slightly, but remained within generally-accepted safety limits.

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Publication of these findings follows soon after a recent study that investigated mechanical power in a model of experimental acute lung injury in pigs (2). Results showed not only an increase in pulmonary neutophilic inflammation after 24 hours of mechanical ventilation, but also a correlation between the degree of inflammation and mechanical power. While it is already established that mechanical power and driving pressure are associated with outcomes in ARDS patients, this porcine model is the first step towards showing a direct association between mechanical power and neutrophilic inflammation.

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References

  1. Buiteman-Kruizinga LA, Mkadmi HE, Serpa Neto A, et al. Effect of INTELLiVENT-ASV versus Conventional Ventilation on Ventilation Intensity in Patients with COVID-19 ARDS—An Observational Study. Journal of Clinical Medicine. 2021; 10(22):5409     
  2. Scharffenberg M, Wittenstein J, Ran X, et al. Mechanical Power Correlates With Lung Inflammation Assessed by Positron-Emission Tomography in Experimental Acute Lung Injury in Pigs. Frontiers in Physiology,  Vol. 12 2021, DOI=10.3389/fphys.2021.717266, https://www.frontiersin.org/article/10.3389/fphys.2021.717266    

Date of Printing: 02.12.2021
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