Effect of INTELLiVENT-ASV versus Conventional Ventilation on Ventilation Intensity in Patients with COVID-19 ARDS-An Observational Study

Laura A Buiteman-Kruizinga; Hassan E Mkadmi; Ary Serpa Neto; Matthijs D Kruizinga; Michela Botta; Marcus J Schultz; Frederique Paulus; Pim L J van der Heiden

doi:10.3390/jcm10225409

Effect of INTELLiVENT-ASV versus Conventional Ventilation on Ventilation Intensity in Patients with COVID-19 ARDS-An Observational Study

J Clin Med. 2021 Nov 19;10(22):5409. doi: 10.3390/jcm10225409.

Authors

Laura A Buiteman-Kruizinga^{1

2}, Hassan E Mkadmi³, Ary Serpa Neto^{2

4

5}, Matthijs D Kruizinga⁶, Michela Botta², Marcus J Schultz^{2

7

8

9}, Frederique Paulus^{2

10}, Pim L J van der Heiden¹

Affiliations

¹ Department of Intensive Care, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands.
² Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', 1105 AZ Amsterdam, The Netherlands.
³ Department of Research, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands.
⁴ Australian and New Zealand Intensive Care-Research Centre (ANZIC-RC), Monash University, Melbourne, VIC 3004, Australia.
⁵ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil.
⁶ Department of Pediatrics, Juliana Children's Hospital, 2545 AA The Hague, The Netherlands.
⁷ Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers, Location 'AMC', 1105 AZ Amsterdam, The Netherlands.
⁸ Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand.
⁹ Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK.
¹⁰ ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, 1105 AZ Amsterdam, The Netherlands.

Abstract

Driving pressure (ΔP) and mechanical power (MP) are associated with outcomes in critically ill patients, irrespective of the presence of Acute Respiratory Distress Syndrome (ARDS). INTELLiVENT-ASV, a fully automated ventilatory mode, controls the settings that affect ΔP and MP. This study compared the intensity of ventilation (ΔP and MP) with INTELLiVENT-ASV versus conventional ventilation in a cohort of COVID-19 ARDS patients in two intensive care units in the Netherlands. The coprimary endpoints were ΔP and MP before and after converting from conventional ventilation to INTELLiVENT-ASV. Compared to conventional ventilation, INTELLiVENT-ASV delivered ventilation with a lower ΔP and less MP. With conventional ventilation, ΔP was 13 cmH₂O, and MP was 21.5 and 24.8 J/min, whereas with INTELLiVENT-ASV, ΔP was 11 and 10 cmH₂O (mean difference -2 cm H2O (95 %CI -2.5 to -1.2 cm H₂O), p < 0.001) and MP was 18.8 and 17.5 J/min (mean difference -7.3 J/Min (95% CI -8.8 to -5.8 J/min), p < 0.001). Conversion from conventional ventilation to INTELLiVENT-ASV resulted in a lower intensity of ventilation. These findings may favor the use of INTELLiVENT-ASV in COVID-19 ARDS patients, but future studies remain needed to see if the reduction in the intensity of ventilation translates into clinical benefits.

Keywords: ARDS; COVID-19; INTELLiVENT-ASV; automated ventilation; closed-loop ventilation; driving pressure; intensity of ventilation; mechanical power.