Closed-Loop Versus Conventional Mechanical Ventilation in COVID-19 ARDS.

Autor: Wendel Garcia PD; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland., Hofmaenner DA; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland., Brugger SD; Division of Infectious Diseases, 27243University Hospital of Zurich, University of Zurich, Zurich, Switzerland., Acevedo CT; Division of Infectious Diseases, 27243University Hospital of Zurich, University of Zurich, Zurich, Switzerland., Bartussek J; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland., Camen G; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland., Bader PR; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland., Bruellmann G; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland., Kattner J; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland., Ganter C; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland., Schuepbach RA; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland., Buehler PK; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland.
Jazyk: angličtina
Zdroj: Journal of intensive care medicine [J Intensive Care Med] 2021 Oct; Vol. 36 (10), pp. 1184-1193. Date of Electronic Publication: 2021 Jun 08.
DOI: 10.1177/08850666211024139
Abstrakt: Background: Lung-protective ventilation is key in bridging patients suffering from COVID-19 acute respiratory distress syndrome (ARDS) to recovery. However, resource and personnel limitations during pandemics complicate the implementation of lung-protective protocols. Automated ventilation modes may prove decisive in these settings enabling higher degrees of lung-protective ventilation than conventional modes.
Method: Prospective study at a Swiss university hospital. Critically ill, mechanically ventilated COVID-19 ARDS patients were allocated, by study-blinded coordinating staff, to either closed-loop or conventional mechanical ventilation, based on mechanical ventilator availability. Primary outcome was the overall achieved percentage of lung-protective ventilation in closed-loop versus conventional mechanical ventilation, assessed minute-by-minute, during the initial 7 days and overall mechanical ventilation time. Lung-protective ventilation was defined as the combined target of tidal volume <8 ml per kg of ideal body weight, dynamic driving pressure <15 cmH 2 O, peak pressure <30 cmH 2 O, peripheral oxygen saturation ≥88% and dynamic mechanical power <17 J/min.
Results: Forty COVID-19 ARDS patients, accounting for 1,048,630 minutes (728 days) of cumulative mechanical ventilation, allocated to either closed-loop (n = 23) or conventional ventilation (n = 17), presenting with a median paO 2 / FiO 2 ratio of 92 [72-147] mmHg and a static compliance of 18 [11-25] ml/cmH 2 O, were mechanically ventilated for 11 [4-25] days and had a 28-day mortality rate of 20%. During the initial 7 days of mechanical ventilation, patients in the closed-loop group were ventilated lung-protectively for 65% of the time versus 38% in the conventional group (Odds Ratio, 1.79; 95% CI, 1.76-1.82; P < 0.001) and for 45% versus 33% of overall mechanical ventilation time (Odds Ratio, 1.22; 95% CI, 1.21-1.23; P < 0.001).
Conclusion: Among critically ill, mechanically ventilated COVID-19 ARDS patients during an early highpoint of the pandemic, mechanical ventilation using a closed-loop mode was associated with a higher degree of lung-protective ventilation than was conventional mechanical ventilation.
Databáze: MEDLINE
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