Adaptive Support Ventilation and Lung-Protective Ventilation in ARDS

Kassis, Elias N Baedorf; Bastos, Andres Brenes; Schaefer, Maximilian S.; Capers, Krystal; Hoenig, Benjamin; Banner‐Goodspeed, Valerie; Talmor, Daniel

doi:10.4187/respcare.10159

Cited by 7 publications

(12 citation statements)

References 19 publications

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“…3 and eTable S3, http://links.lww.com/EJA/A926). With ASV, V T increased in cardiac surgery patients 17 and in ARDS patients 42 . ASV decreased V T in ARDS patients, 55 but did not affect V T in cardiac surgery 48,51 and COPD patients 21,47 .…”

Section: Resultsmentioning

confidence: 90%

“…The search identified a total of 801 studies; after removal of duplicates and screening for eligibility, 45 studies in adult 13–57 and six studies in paediatric patients 58–63 were considered for this analysis (Fig. 1 and eTable S1, http://links.lww.com/EJA/A926).…”

Section: Resultsmentioning

confidence: 99%

“…1 and eTable S1, http://links.lww.com/EJA/A926). Thirty-five studies had a parallel randomised design 13–19,21,23,25–31,33,34,36,38–40,43–57,62,63 ; 12 had a crossover randomised design 20,22,24,32,35,37,41,42,58–61 . Only five studies were multicentre investigations 23,33,36,38,39 .…”

Section: Resultsmentioning

confidence: 99%

“…Only five studies were multicentre investigations 23,33,36,38,39 . Most studies were performed in critically ill patients with respiratory failure 15,16,18,22,24,26,27,29–31,33,35,36,39,41,46,47,54,62 ; twelve studies in patients after cardiac surgery 13,17,25,28,34,48–51,57 or general surgery, 20,23,43 four in difficult to wean patients, 19,32,38,40,56 four in COPD patients 14,21,44,45 and four in ARDS patients 37,42,53,55 . Nine studies tested SmartCare, 14,15,18,19,23,32,47,54,63 fourteen studies ASV, 13,17,21,42,43,45,46,48–53,55 eight studies INTELLiVENT–ASV, 22,24,25,27,28,30,34,35 eight studies NAVA, 20,36–41,62 six studies PAV+, 16,26,29,31,33,44 three studies Avea–CLiO 2 58–60 and one closed loop FiO 2 titrations during ASV 61 .…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-five studies had a parallel randomised design [13][14][15][16][17][18][19]21,23,[25][26][27][28][29][30][31]33,34,36,[38][39][40][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]62,63 ; 12 had a crossover randomised design. 20,22,24,32,35,37,41,42,[58][59][60][61] Only five studies were multicentre investigations. 23,…”

Section: Search Results and Risk Of Biasmentioning

confidence: 99%

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Effects of closed loop ventilation on ventilator settings, patient outcomes and ICU staff workloads – a systematic review

Goossen,

Schultz,

Tschernko

et al. 2024

European Journal of Anaesthesiology

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BACKGROUND Lung protective ventilation is considered standard of care in the intensive care unit. However, modifying the ventilator settings can be challenging and is time consuming. Closed loop modes of ventilation are increasingly attractive for use in critically ill patients. With closed loop ventilation, settings that are typically managed by the ICU professionals are under control of the ventilator's algorithms. OBJECTIVES To describe the effectiveness, safety, efficacy and workload with currently available closed loop ventilation modes. DESIGN Systematic review of randomised clinical trials. DATA SOURCES A comprehensive systematic search in PubMed, Embase and the Cochrane Central register of Controlled Trials search was performed in January 2023. ELIGIBILITY CRITERIA Randomised clinical trials that compared closed loop ventilation with conventional ventilation modes and reported on effectiveness, safety, efficacy or workload. RESULTS The search identified 51 studies that met the inclusion criteria. Closed loop ventilation, when compared with conventional ventilation, demonstrates enhanced management of crucial ventilator variables and parameters essential for lung protection across diverse patient cohorts. Adverse events were seldom reported. Several studies indicate potential improvements in patient outcomes with closed loop ventilation; however, it is worth noting that these studies might have been underpowered to conclusively demonstrate such benefits. Closed loop ventilation resulted in a reduction of various aspects associated with the workload of ICU professionals but there have been no studies that studied workload in sufficient detail. CONCLUSIONS Closed loop ventilation modes are at least as effective in choosing correct ventilator settings as ventilation performed by ICU professionals and have the potential to reduce the workload related to ventilation. Nevertheless, there is a lack of sufficient research to comprehensively assess the overall impact of these modes on patient outcomes, and on the workload of ICU staff.

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