A recent publication from Turkey found that a closed-loop ventilation mode resulted in significantly lower driving pressures than a conventional ventilation mode in a heterogeneous group of pediatric patients.
The randomized crossover trial was conducted at the Dr Behcet Uz Children's Disease and Surgery Training and Research Hospital in Izmir with the aim of comparing the driving pressure in Adaptive Support Ventilation (ASV) 1.1 with the driving pressure in physician-tailored APV-CMV modes. A total of 26 patients with a median age of 16 months and different lung conditions were enrolled. The investigators compared two 60-minute periods of ventilation in APV-CMV and ASV 1.1, whereby settings were adjusted to achieve the same minute ventilation in the two modes.
Results showed that the median driving pressure was significantly lower during the ASV 1.1 period than during the APV-CMV period (10.4 (8.5−12.1 [IQR]) and 12.4 (10.5−15.3 [IQR]) cmH2O, respectively (p < .001)). The median tidal volume of 6.4 (5.1−7.3 [IQR]) ml/kg and respiratory rate of 41 (33−50 [IQR]) b/min selected by the ASV 1.1 algorithm compared with a median tidal volume of 7.9 (6.8−8.3 [IQR]) ml/kg and respiratory rate of 31 (26−41[IQR]) b/min in the APV-CMV period. The authors concluded that ASV 1.1 resulted in lower driving pressures than APV-CMV modes and may therefore result in continued, safe ventilation in a heterogenous pediatric patient group.
Ceylan, G, Topal, S, Atakul, G, et al. Randomized crossover trial to compare driving pressures in a closed-loop and a conventional mechanical ventilation mode in pediatric patients. Pediatric Pulmonology. 2021; 1- 9.
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