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The new HAMILTON-C6.

Supporting your entire ventilation workflow

The new HAMILTON-C6

Our intelligent ICU ventilator. The new HAMILTON-C6

  • With all advanced ventilation modes and therapies
  • For adult, pediatric, and neonatal patient groups
  • Featuring a wide range of diagnostic tools
  • Peak flow of 260 l/min
The new HAMILTON-C6
The new HAMILTON-C6

Our intelligent ICU ventilator. The new HAMILTON-C6

  • With all advanced ventilation modes and therapies
  • For adult, pediatric, and neonatal patient groups
  • Featuring a wide range of diagnostic tools
  • Peak flow of 260 l/min
The new HAMILTON-C6

On the big screen. Important ICU ventilation data at a glance

  • 17-inch detachable touch screen
  • Configurable screen setups
  • Over 50 monitoring parameters
  • 72-hour trends
  • Customizable toolbar for instant access to your favorite apps
The new HAMILTON-C6
The new HAMILTON-C6

Guaranteed to last. Our high-performance turbine

  • Independent from compressed air
  • Lifetime turbine warranty
  • Whisper-quiet operation
  • High-performance NIV
  • High peak pressure
The new HAMILTON-C6

One screen. Seamless control of the humidifier

  • See all controls, monitoring values, and alarms at a glance
  • Operate the HAMILTON-H900 humidifier comfortably directly from the ventilator display
  • The HAMILTON-H900 automatically adapts humidification to the ventilation mode
The new HAMILTON-C6

Fiercely independent. No compressed air and battery powered

  • High‑performance turbine
  • Typically 1.5 hours of battery time with one battery, 3 hours with two batteries
  • Two oxygen cylinder holders
The new HAMILTON-C6

Dynamic Lung and Lung Impact panels. See what matters most

  • Dynamic Lung visualizes changes in compliance and resistance in real time
  • New layout includes Rcexp range and P0.1
  • Lung Impact panel provides critical lung-protective parameters at a glance
  • Displays automated calculations of mechanical power
The new HAMILTON-C6 workflow support

More than just features. An entire workflow solution

The new HAMILTON-C6 supports you along the entire patient journey - from admission right through to weaning - with advanced tools and functionalities to facilitate your complete workflow. In addition, we have developed new, targeted solutions designed to aid you at each phase of that journey.

Instead of focusing on isolated features, we have taken a holistic approach that transforms fragmented tasks into a streamlined, intuitive process. The result is an entire workflow solution designed for greater operational efficiency, even in the most demanding care environments.

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Designed to be different. Select the setup that fits your needs

This one is as flexible as they come! You can put it on a trolley, attach it to a pendant, take off its head or position it on a shelf.

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Data for the big picture. Comprehensive connectivity solutions for PDMS, monitoring, and EMR

Graphic illustration: two nurses assist intubated patients with walking

The sooner the better. Early mobilization

With its high-performance turbine, battery, compact size, and state-of-the-art ventilation modes, the new HAMILTON-C6 is also at your patient's side for their first steps out of bed.

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Training to go. The Hamilton
Medical VenTrainer App

Learn anywhere, anytime with our VenTrainer App. It simulates every Hamilton Medical ventilator in 3D, with a fully functional user interface, real-time monitoring values, and a realistic physiologic patient model with adjustable conditions (COPD, ARDS).

Additional training and learning scenarios offer you a guided, hands-on learning experience.

Want to see more?
Explore the 3D model

Discover the new HAMILTON-C6 ventilator from every angle and click on the hotspots to learn more.

For quick details

  • Standard
  • Opzione
  • Non disponibile
Gruppi di pazienti Adult/Ped, Neonatal
Dimensioni (L × P × A) 17 in (431.8 mm) diagonal
1920 x 1200 pixels
Peso Monitor (interaction panel) without shelf mount: 7.8 kg (17.2 lb)
Monitor with shelf mount: 10 kg (22 lb)
Ventilation unit with shelf mount: 10.5 kg (23.2 lb)
Ventilation unit, monitor, and trolley: 46 kg (101 lb)
Dimensioni e risoluzione del monitor 423 x 250 x 415 mm (monitor)
360 x 250 x 394 mm (ventilation unit)
640 x 560 x 1400 mm (incl. trolley)
Monitor staccabile
Tempo di funzionamento della batteria 1.5 h with one battery
3 h with two batteries
Batteria sostituibile a caldo
Alimentazione aria Integrated turbine with warranty for the expected lifetime of the new HAMILTON‑C6 ventilator
Connettore O2 DISS (CGA 1240) or NIST
Connettività Three COM ports, two USB ports, DVI, Nurse call
Volume 37 dB in normal operation
A volume controllato, a flusso controllato
A target di volume, a pressione adattiva controllata
Pressure-controlled
Ventilazione intelligente ASV®, INTELLiVENT®‑ASV® (option)
Ventilazione non invasiva
Flusso alto
Visualizzazione della meccanica polmonare (PolmDin)
Visualizzazione della dipendenza del paziente dal ventilatore
Capnografia
Monitoraggio della SpO2
Lung stress and strain monitoring (Lung Impact panel)
Misurazione della pressione esofagea
Valutazione e reclutamento polmonari (P/V Tool Pro)
Sincronizzazione paziente-ventilatore (IntelliSync+)
Ventilazione per RCP
Modulo Hamilton Connect
Suctioning tool
SpeakValve compatibility
On-screen help
O2 assist
Connessione da remoto all’umidificatore HAMILTON-H900
Controller integrato della pressione di cuffia IntelliCuff
Nebulizzatore pneumatico integrato
Nebulizzatore Aerogen integrato
Compatibilità con il sistema di anestesia Sedaconda ACD-S
Dr. João Alves

Cosa dicono i clienti

One of the pearls of these ventilators is the interface. I think the interface of the HAMILTON-C6 has a completely new level of monitoring capabilities.

Dr. João Alves

Intensivist, Internal Medicine and Emergency Department since 2018
University Hospital Center Lisbon, Lisbon, Portugal

For your patients

ASV® – Adaptive Support Ventilation®: Adattamento giorno e notte

La modalità di ventilazione ASV regola costantemente, respiro per respiro, la frequenza respiratoria, il volume corrente e il tempo inspiratorio in base alla meccanica polmonare e allo sforzo del paziente: 24 ore su 24, dall'intubazione all'estubazione.

INTELLiVENT®-ASV: Un assistente al posto letto

La modalità di ventilazione intelligente INTELLiVENT-ASV controlla costantemente la ventilazione e l'ossigenazione del paziente.

Regola ventilazione minuto, PEEP e Ossigeno basandosi sui target impostati dall'operatore e sui dati fisiologici del paziente.

O2 assist: gestione dell'ossigeno

O2 assist è una tecnologia avanzata per la gestione dell'ossigeno che interviene con precisione come farebbe un assistente al posto letto. Regolando in modo continuo l'apporto di ossigeno, mantiene i livelli di SpO2 entro gli intervalli target impostati per lo specifico paziente. Consente così di non sprecare tempo a girare manopole (Roca O, Caritg O, Santafé M, et al. Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study). Crit Care. 2022;26(1):108. Published 2022 Apr 14. doi:10.1186/s13054-022-03970-w105​, Atakul G, Ceylan G, Sandal O, et al. Closed-loop oxygen usage during invasive mechanical ventilation of pediatric patients (CLOUDIMPP): a randomized controlled cross-over study. Front Med (Lausanne). 2024;11:1426969. Published 2024 Sep 10. doi:10.3389/fmed.2024.1426969106​) e contribuisce a ridurre il rischio di iperossiemia e ipossiemia nei pazienti (Sandal O, Ceylan G, Topal S, et al. Closed-loop oxygen control improves oxygenation in pediatric patients under high-flow nasal oxygen-A randomized crossover study. Front Med (Lausanne). 2022;9:1046902. Published 2022 Nov 16. doi:10.3389/fmed.2022.1046902107​, Trottier M, Bouchard PA, L'Her E, Lellouche F. Automated Oxygen Titration During CPAP and Noninvasive Ventilation in Healthy Subjects With Induced Hypoxemia. Respir Care. 2023;68(11):1553-1560. doi:10.4187/respcare.09866108).

IntelliSync®+: Per la sincronia tra paziente e ventilatore

Analizzando costantemente le forme delle curve, centinaia di volte al secondo, IntelliSync+ può rilevare immediatamente gli sforzi e il ciclaggio del paziente, e attivare quindi in tempo reale inspirazione ed espirazione.

IntelliSync+ funziona sia con ventilazione invasiva sia con ventilazione non invasiva, indipendentemente dalla modalità di ventilazione scelta.

Accedere all'umidificatore da remoto: una soluzione pratica

Questa opzione di connettività del ventilatore consente di utilizzare direttamente dal display del ventilatore anche l'umidificatore HAMILTON-H900 (L'HAMILTON-H900 non è approvato per l'uso durante il trasporto.e). È possibile accedere a tutti i comandi, parametri di monitoraggio e allarmi, oltre a regolarli in base alle esigenze.

È inoltre possibile far sì che l'umidificatore selezioni automaticamente la modalità di umidificazione (invasiva, non invasiva e ad alto flusso) in base alla modalità di ventilazione selezionata.

IntelliCuff® integrato: per una pressione di cuffia sotto controllo

IntelliCuff misura costantemente la pressione di cuffia di un tubo tracheostomico o endotracheale e mantiene automaticamente e in tempo reale il valore impostato dall'utente (Modalità Auto di IntelliCuff non disponibile in tutti i mercati.c).

P/V Tool®: valutazione e reclutamento polmonari

Con P/V Tool è possibile valutare la reclutabilità polmonare e stabilire la strategia di reclutamento da adottare.

Lo si può anche utilizzare per eseguire una manovra di reclutamento mediante inflazione sostenuta e per misurare l'aumento di volume dei polmoni.

Volume support. For seamless workflows

Volume Support offers a tidal volume-targeted mode without a fixed mandatory rate, now available for neonatal, pediatric, and adult patients. It delivers flow-cycled breaths that automatically adjust pressure support to meet the set tidal volume. This ensures smooth weaning while following a volume-controlled strategy, without compromising patient comfort or safety.

Monitoraggio della pressione transpolmonare: raccolta dati dall'interno

Il monitoraggio della pressione transpolmonare consente di ottimizzare PEEP, volume corrente e pressione inspiratoria (Baedorf Kassis E, Loring SH, Talmor D. Should we titrate peep based on end-expiratory transpulmonary pressure?-yes. Ann Transl Med. 2018;6(19):390. doi:10.21037/atm.2018.06.35104).

L'utilizzo in combinazione con P/V Tool permette di valutare la possibilità di reclutamento polmonare ed eseguire manovre di reclutamento.

Nebulizzatore integrato: utile per i trattamenti aggiuntivi

Il nebulizzatore pneumatico integrato è perfettamente sincronizzato con i tempi di inspirazione ed espirazione.

È disponibile come opzione un nebulizzatore integrato e sincronizzato Aerogen (Non disponibile in tutti i mercatia, Disponibile solo per i ventilatori HAMILTON-C6/G5/S1b).

L'erogazione di farmaci nebulizzati a creare un aerosol contribuisce a contrastare il broncospasmo, ad aumentare l'efficienza della ventilazione e a ridurre l'ipercapnia (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).

Terapia ad alto flusso con cannula nasale: per chi non può rinunciare all'O2

La terapia ad alto flusso con cannula nasale (Detta anche "terapia con ossigeno ad alto flusso": questo termine è perfettamente equivalente a "terapia ad alto flusso con cannula nasale"f) è disponibile come opzione su tutti i nostri ventilatori. In solo pochi passaggi è possibile cambiare l'interfaccia e utilizzare lo stesso dispositivo e circuito paziente per soddisfare ogni esigenza terapeutica.

La funzione è disponibile anche sul nostro dispositivo autonomo per la terapia con ossigeno ad alto flusso, l'HAMILTON-HF90 (Non disponibile in tutti i mercatia).

Ventilazione per RCP: per salvare vite umane

La ventilazione per RCP adatta le impostazioni del ventilatore durante la rianimazione. Supporta il flusso di lavoro della RCP consentendo di accedere rapidamente a impostazioni preconfigurabili, regolazioni adeguate di allarmi e trigger e visualizzazione di un timer RCP.

Sullo schermo vengono inoltre visualizzati i parametri di monitoraggio principali e le curve rilevanti per la ventilazione per RCP.

Valvola fonatoria: per i più chiacchieroni

L'opzione per l'uso con valvola fonatoria restituisce la voce ai pazienti tracheostomizzati e permette loro di deglutire anche mentre il supporto respiratorio è attivo.

Le funzioni di monitoraggio, trigger e gestione degli allarmi sul ventilatore sono modificate per essere compatibili con l'uso di una valvola fonatoria nelle modalità a pressione controllata (PCV+, SPONT, PSIMV+).

Capnografia volumetrica: per i CO2ntrol freak

La misurazione della CO2 e del flusso prossimale consente ai nostri ventilatori di effettuare la capnografia volumetrica con tecniche moderne: una base importante per la valutazione della qualità della ventilazione e dell'attività metabolica.

Lung Impact panel. All parameters at a glance

The Lung Impact panel provides a visual representation of four key parameters for lung-protective ventilation. It enables you to monitor these critical values at a glance and make informed decisions in real time. The automated calculation of mechanical power eliminates time-consuming manual work, helping to streamline your workflow.

Pannello StatoVent: pronti per lo svezzamento?

Il pannello StatoVent visualizza sei parametri relativi alla dipendenza del paziente dal ventilatore, tra cui l'ossigenazione, l'eliminazione della CO2 e l'attività del paziente.

Un cursore fluttuante si muove in su e in giù all'interno di ogni colonna mostrando il valore attuale di un dato parametro.

Svezzamento veloce: per chi ha sete di indipendenza

Lo "Svezzamento veloce" è una funzione della modalità INTELLiVENT-ASV che consente il monitoraggio dinamico continuo e il controllo delle condizioni del paziente per valutare se quest'ultimo è potenzialmente pronto per l'estubazione.

SBT automatici: per non rinunciare alla spontaneità

I tentativi automatici di respirazione spontanea (SBT) sono parte della funzione "Svezz. veloce" della modalità INTELLiVENT-ASV e permettono di eseguire SBT totalmente controllati.

Pannello PolmDin: per vedere con i propri occhi

Il pannello PolmDin mostra all'operatore una rappresentazione grafica in tempo reale di questi importanti dati di monitoraggio:

  • Compliance e resistenza
  • Trigger del paziente
  • SpO2
  • Frequenza del polso

Loop e trend configurabili: per chi ama la statistica

Il ventilatore può visualizzare un loop dinamico basato su una combinazione selezionata di parametri monitorati. Grazie alla funzione di trend, è possibile visualizzare sullo schermo le tendenze dei dati relativi ai parametri di monitoraggio e all'intervallo temporale desiderati. 

Il dispositivo registra costantemente in memoria i dati sui parametri monitorati, anche quando è in Standby.

Saturimetria: la SpO2 non ha più segreti

L'opzione SpO2 permette la misurazione integrata non invasiva della SpO2 con comoda visualizzazione dei dati direttamente sul ventilatore.

Mettiamo inoltre a disposizione un'ampia gamma di sensori di SpO2.

Ventilazione non invasiva ad alte prestazioni: dietro la maschera

Le modalità di ventilazione non invasiva erogano respiri spontanei a supporto di pressione e con ciclaggio a flusso (modalità NIV e NIV-ST) e respiri meccanici a pressione controllata e con ciclaggio a tempo (NIV-ST).

Rispetto ai ventilatori che utilizzano l'aria compressa, i nostri ventilatori a turbina sono in grado di fornire flussi di picco maggiori. In questo modo le prestazioni sono ottimali anche in presenza di perdite consistenti.

Modalità nCPAP: per i più piccoli

Le modalità per nCPAP sono progettate in modo tale che il medico debba soltanto inserire la pressione di CPAP desiderata. Il flusso viene regolato di conseguenza in base alle condizioni del paziente e alle potenziali perdite. In questo modo è possibile evitare pressioni di picco non previste, garantire una compensazione delle perdite efficiente e contribuire a ridurre il consumo di ossigeno. Le regolazioni del flusso avvengono con estrema rapidità grazie all'elevata sensibilità delle misurazioni di pressione.

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.14-25991​, 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.2016.01.0182​, 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.00000000000005893​).

Our intelligent ventilation mode INTELLiVENT-ASV promotes you from knob-turner to supervisor, reduces the number of manual interactions with the ventilator (Beijers AJ, Roos AN, Bindels AJ. Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients. Intensive Care Med. 2014;40(5):752-753. doi:10.1007/s00134-014-3234-74​, 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. 5​, 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.2017.000316​), 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. 5​, 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.2017.000316​, 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.2019.11.0017​), from intubation to extubation.

O2 assist is an advanced oxygen management technology that acts as your precision-care assistant at the bedside. By continuously adjusting the oxygen supply, it maintains the patient’s SpO2 levels within the individually set target ranges. This ensures less knob-turning for you (Roca O, Caritg O, Santafé M, et al. Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study). Crit Care. 2022;26(1):108. Published 2022 Apr 14. doi:10.1186/s13054-022-03970-w105​, Atakul G, Ceylan G, Sandal O, et al. Closed-loop oxygen usage during invasive mechanical ventilation of pediatric patients (CLOUDIMPP): a randomized controlled cross-over study. Front Med (Lausanne). 2024;11:1426969. Published 2024 Sep 10. doi:10.3389/fmed.2024.1426969106​) and helps lower the risk of hyperoxemia and hypoxemia for your patients (Sandal O, Ceylan G, Topal S, et al. Closed-loop oxygen control improves oxygenation in pediatric patients under high-flow nasal oxygen-A randomized crossover study. Front Med (Lausanne). 2022;9:1046902. Published 2022 Nov 16. doi:10.3389/fmed.2022.1046902107​, Trottier M, Bouchard PA, L'Her E, Lellouche F. Automated Oxygen Titration During CPAP and Noninvasive Ventilation in Healthy Subjects With Induced Hypoxemia. Respir Care. 2023;68(11):1553-1560. doi:10.4187/respcare.09866108​).

IntelliSync+ continuously analyzes waveform signals at least one hundred times per second. This enables IntelliSync+ to detect patient efforts immediately and to initiate inspiration and expiration in real-time, thus replacing conventional trigger settings for inspiration and expiration.

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.033878​) 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.

Patient in wheelchair with ventilator

Farewell ventilator! Tools to implement your weaning protocols

We want our ventilator to leave your patient’s side as quickly as possible. That is why we provide you with tools to help you implement your weaning protocol.

These include visual aids and ventilation modes designed to encourage spontaneous breathing.

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.

Test your newly learned skills safely on the simulator in our VenTrainer App.

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.
Foto di un dipendente

Parlate con i nostri esperti. Discutiamo delle vostre esigenze

Il nostro team di esperti di ventilazione è lieto di assistervi nella scelta del ventilatore perfetto per il vostro ambiente clinico e di aiutarvi a raggiungere i vostri obiettivi terapeutici. Richiedete un preventivo personalizzato o richiedete una telefonata per maggiori informazioni.

Bibliografia

  1. 1. 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
  2. 2. 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
  3. 3. 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
  4. 4. Beijers AJ, Roos AN, Bindels AJ. Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients. Intensive Care Med. 2014;40(5):752-753. doi:10.1007/s00134-014-3234-7
  5. 5. 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. 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.2017.00031
  7. 7. 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
  8. 8. 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

 

  1. 100. Dhand R. New frontiers in aerosol delivery during mechanical ventilation. Respir Care. 2004;49(6):666-677.
  2. 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
  3. 104. Baedorf Kassis E, Loring SH, Talmor D. Should we titrate peep based on end-expiratory transpulmonary pressure?-yes. Ann Transl Med. 2018;6(19):390. doi:10.21037/atm.2018.06.35
  4. 105. Roca O, Caritg O, Santafé M, et al. Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study). Crit Care. 2022;26(1):108. Published 2022 Apr 14. doi:10.1186/s13054-022-03970-w
  5. 106. Atakul G, Ceylan G, Sandal O, et al. Closed-loop oxygen usage during invasive mechanical ventilation of pediatric patients (CLOUDIMPP): a randomized controlled cross-over study. Front Med (Lausanne). 2024;11:1426969. Published 2024 Sep 10. doi:10.3389/fmed.2024.1426969
  6. 107. Sandal O, Ceylan G, Topal S, et al. Closed-loop oxygen control improves oxygenation in pediatric patients under high-flow nasal oxygen-A randomized crossover study. Front Med (Lausanne). 2022;9:1046902. Published 2022 Nov 16. doi:10.3389/fmed.2022.1046902
  7. 108. Trottier M, Bouchard PA, L'Her E, Lellouche F. Automated Oxygen Titration During CPAP and Noninvasive Ventilation in Healthy Subjects With Induced Hypoxemia. Respir Care. 2023;68(11):1553-1560. doi:10.4187/respcare.09866

Note

  • a. Non disponibile in tutti i mercati
  • b. Disponibile solo per i ventilatori HAMILTON-C6/G5/S1
  • c. La modalità Auto di IntelliCuff non è disponibile in tutti i mercati

 

  • e. L'HAMILTON-H900 non è approvato per l'uso durante il trasporto
  • f. Nota anche come "terapia con ossigeno ad alto flusso". Questo termine e il termine "terapia ad alto flusso con cannula nasale" sono equivalenti.

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.

Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients.

Beijers AJ, Roos AN, Bindels AJ. Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients. Intensive Care Med. 2014;40(5):752-753. doi:10.1007/s00134-014-3234-7

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.

Should we titrate peep based on end-expiratory transpulmonary pressure?-yes.

Baedorf Kassis E, Loring SH, Talmor D. Should we titrate peep based on end-expiratory transpulmonary pressure?-yes. Ann Transl Med. 2018;6(19):390. doi:10.21037/atm.2018.06.35

Ventilator management of patients with acute respiratory distress syndrome (ARDS) has been characterized by implementation of basic physiology principles by minimizing harmful distending pressures and preventing lung derecruitment. Such strategies have led to significant improvements in outcomes. Positive end expiratory pressure (PEEP) is an important part of a lung protective strategy but there is no standardized method to set PEEP level. With widely varying types of lung injury, body habitus and pulmonary mechanics, the use of esophageal manometry has become important for personalization and optimization of mechanical ventilation in patients with ARDS. Esophageal manometry estimates pleural pressures, and can be used to differentiate the chest wall and lung (transpulmonary) contributions to the total respiratory system mechanics. Elevated pleural pressures may result in negative transpulmonary pressures at end expiration, leading to lung collapse. Measuring the esophageal pressures and adjusting PEEP to make transpulmonary pressures positive can decrease atelectasis, derecruitment of lung, and cyclical opening and closing of airways and alveoli, thus optimizing lung mechanics and oxygenation. Although there is some spatial and positional artifact, esophageal pressures in numerous animal and human studies in healthy, obese and critically ill patients appear to be a good estimate for the "effective" pleural pressure. Multiple studies have illustrated the benefit of using esophageal pressures to titrate PEEP in patients with obesity and with ARDS. Esophageal pressure monitoring provides a window into the unique physiology of a patient and helps improve clinical decision making at the bedside.

Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study).

Roca O, Caritg O, Santafé M, et al. Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study). Crit Care. 2022;26(1):108. Published 2022 Apr 14. doi:10.1186/s13054-022-03970-w

BACKGROUND We aimed to assess the efficacy of a closed-loop oxygen control in critically ill patients with moderate to severe acute hypoxemic respiratory failure (AHRF) treated with high flow nasal oxygen (HFNO). METHODS In this single-centre, single-blinded, randomized crossover study, adult patients with moderate to severe AHRF who were treated with HFNO (flow rate ≥ 40 L/min with FiO2 ≥ 0.30) were randomly assigned to start with a 4-h period of closed-loop oxygen control or 4-h period of manual oxygen titration, after which each patient was switched to the alternate therapy. The primary outcome was the percentage of time spent in the individualized optimal SpO2 range. RESULTS Forty-five patients were included. Patients spent more time in the optimal SpO2 range with closed-loop oxygen control compared with manual titrations of oxygen (96.5 [93.5 to 98.9] % vs. 89 [77.4 to 95.9] %; p < 0.0001) (difference estimate, 10.4 (95% confidence interval 5.2 to 17.2). Patients spent less time in the suboptimal range during closed-loop oxygen control, both above and below the cut-offs of the optimal SpO2 range, and less time above the suboptimal range. Fewer number of manual adjustments per hour were needed with closed-loop oxygen control. The number of events of SpO2 < 88% and < 85% were not significantly different between groups. CONCLUSIONS Closed-loop oxygen control improves oxygen administration in patients with moderate-to-severe AHRF treated with HFNO, increasing the percentage of time in the optimal oxygenation range and decreasing the workload of healthcare personnel. These results are especially relevant in a context of limited oxygen supply and high medical demand, such as the COVID-19 pandemic. Trial registration The HILOOP study was registered at www. CLINICALTRIALS gov under the identifier NCT04965844 .

Closed-loop oxygen usage during invasive mechanical ventilation of pediatric patients (CLOUDIMPP): a randomized controlled cross-over study.

Atakul G, Ceylan G, Sandal O, et al. Closed-loop oxygen usage during invasive mechanical ventilation of pediatric patients (CLOUDIMPP): a randomized controlled cross-over study. Front Med (Lausanne). 2024;11:1426969. Published 2024 Sep 10. doi:10.3389/fmed.2024.1426969

BACKGROUND The aim of this study is the evaluation of a closed-loop oxygen control system in pediatric patients undergoing invasive mechanical ventilation (IMV). METHODS Cross-over, multicenter, randomized, single-blind clinical trial. Patients between the ages of 1 month and 18 years who were undergoing IMV therapy for acute hypoxemic respiratory failure (AHRF) were assigned at random to either begin with a 2-hour period of closed-loop oxygen control or manual oxygen titrations. By using closed-loop oxygen control, the patients' SpO2 levels were maintained within a predetermined target range by the automated adjustment of the FiO2. During the manual oxygen titration phase of the trial, healthcare professionals at the bedside made manual changes to the FiO2, while maintaining the same target range for SpO2. Following either period, the patient transitioned to the alternative therapy. The outcomes were the percentage of time spent in predefined SpO2 ranges ±2% (primary), FiO2, total oxygen use, and the number of manual adjustments. FINDINGS The median age of included 33 patients was 17 (13-55.5) months. In contrast to manual oxygen titrations, patients spent a greater proportion of time within a predefined optimal SpO2 range when the closed-loop oxygen controller was enabled (95.7% [IQR 92.1-100%] vs. 65.6% [IQR 41.6-82.5%]), mean difference 33.4% [95%-CI 24.5-42%]; P < 0.001). Median FiO2 was lower (32.1% [IQR 23.9-54.1%] vs. 40.6% [IQR 31.1-62.8%]; P < 0.001) similar to total oxygen use (19.8 L/h [IQR 4.6-64.8] vs. 39.4 L/h [IQR 16.8-79]; P < 0.001); however, median SpO2/FiO2 was higher (329.4 [IQR 180-411.1] vs. 246.7 [IQR 151.1-320.5]; P < 0.001) with closed-loop oxygen control. With closed-loop oxygen control, the median number of manual adjustments reduced (0.0 [IQR 0.0-0.0] vs. 1 [IQR 0.0-2.2]; P < 0.001). CONCLUSION Closed-loop oxygen control enhances oxygen therapy in pediatric patients undergoing IMV for AHRF, potentially leading to more efficient utilization of oxygen. This technology also decreases the necessity for manual adjustments, which could reduce the workloads of healthcare providers. CLINICAL TRIAL REGISTRATION This research has been submitted to ClinicalTrials.gov (NCT05714527).

Closed-loop oxygen control improves oxygenation in pediatric patients under high-flow nasal oxygen-A randomized crossover study.

Sandal O, Ceylan G, Topal S, et al. Closed-loop oxygen control improves oxygenation in pediatric patients under high-flow nasal oxygen-A randomized crossover study. Front Med (Lausanne). 2022;9:1046902. Published 2022 Nov 16. doi:10.3389/fmed.2022.1046902

BACKGROUND We assessed the effect of a closed-loop oxygen control system in pediatric patients receiving high-flow nasal oxygen therapy (HFNO). METHODS A multicentre, single-blinded, randomized, and cross-over study. Patients aged between 1 month and 18 years of age receiving HFNO for acute hypoxemic respiratory failure (AHRF) were randomly assigned to start with a 2-h period of closed-loop oxygen control or a 2-h period of manual oxygen titrations, after which the patient switched to the alternative therapy. The endpoints were the percentage of time spent in predefined SpO2 ranges (primary), FiO2, SpO2/FiO2, and the number of manual adjustments. FINDINGS We included 23 patients, aged a median of 18 (3-26) months. Patients spent more time in a predefined optimal SpO2 range when the closed-loop oxygen controller was activated compared to manual oxygen titrations [91⋅3% (IQR 78⋅4-95⋅1%) vs. 63⋅0% (IQR 44⋅4-70⋅7%)], mean difference [28⋅2% (95%-CI 20⋅6-37⋅8%); P < 0.001]. Median FiO2 was lower [33⋅3% (IQR 26⋅6-44⋅6%) vs. 42⋅6% (IQR 33⋅6-49⋅9%); P = 0.07], but median SpO2/FiO2 was higher [289 (IQR 207-348) vs. 194 (IQR 98-317); P = 0.023] with closed-loop oxygen control. The median number of manual adjustments was lower with closed-loop oxygen control [0⋅0 (IQR 0⋅0-0⋅0) vs. 0⋅5 (IQR 0⋅0-1⋅0); P < 0.001]. CONCLUSION Closed-loop oxygen control improves oxygenation therapy in pediatric patients receiving HFNO for AHRF and potentially leads to more efficient oxygen use. It reduces the number of manual adjustments, which may translate into decreased workloads of healthcare providers. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT05032365].

Automated Oxygen Titration During CPAP and Noninvasive Ventilation in Healthy Subjects With Induced Hypoxemia.

Trottier M, Bouchard PA, L'Her E, Lellouche F. Automated Oxygen Titration During CPAP and Noninvasive Ventilation in Healthy Subjects With Induced Hypoxemia. Respir Care. 2023;68(11):1553-1560. doi:10.4187/respcare.09866

BACKGROUND Automated oxygen titration to maintain a stable SpO2 has been developed for spontaneously breathing patients but has not been evaluated during CPAP and noninvasive ventilation (NIV). METHODS We performed a randomized controlled crossover, double-blind study on 10 healthy subjects with induced hypoxemia during 3 situations: spontaneous breathing with oxygen support, CPAP (5 cm H2O), and NIV (7/3 cm H2O). We conducted in random order 3 dynamic hypoxic challenges of 5 min (FIO2 0.08 ± 0.02, 0.11± 0.02, and 0.14 ± 0.02). For each condition, we compared automated oxygen titration and manual oxygen titration by experienced respiratory therapists (RTs), with the aim to maintain the SpO2 at 94 ± 2%. In addition, we included 2 subjects hospitalized for exacerbation of COPD under NIV and a subject managed after bariatric surgery with CPAP and automated oxygen titration. RESULTS The percentage of time in the SpO2 target was higher with automated compared with manual oxygen titration for all conditions, on average 59.6 ± 22.8% compared to 44.3 ± 23.9% (P = .004). Hyperoxemia (SpO2 > 96%) was less frequent with automated titration for each mode of oxygen administration (24.0 ± 24.4% vs 39.1 ± 25.3%, P < .001). During the manual titration periods, the RT made several changes to oxygen flow (5.1 ± 3.3 interventions that lasted 122 ± 70 s/period) compared to none during the automated titration to maintain oxygenation in the targeted SpO2 . Time in the SpO2 target was higher with stable hospitalized subjects in comparison with healthy subjects under dynamic-induced hypoxemia. CONCLUSIONS In this proof-of-concept study, automated oxygen titration was used during CPAP and NIV. The performances to maintain the SpO2 target were significantly better compared to manual oxygen titration in the setting of this study protocol. This technology may allow decreasing the number of manual interventions for oxygen titration during CPAP and NIV.