Abstract
BackgroundHypoxia is common during daily nursing procedures (DNPs) routinely performed on mechanically ventilated patients. The impact of automated ventilation on the incidence and severity of blood oxygen desaturation during DNPs remains unknown.MethodsA prospective randomized controlled crossover trial was carried out in a French intensive care unit to compare blood oxygen pulse saturation (SpO2) during DNPs performed on patients mechanically ventilated in automated and conventional ventilation modes (AV and CV, respectively). All patients with FiO2 ≤ 60% and without prone positioning or neuromuscular blocking agents were included. Patients underwent two DNPs on the same day using AV (INTELLiVENT-ASV®) and CV (volume control, biphasic positive airway pressure, or pressure support ventilation) in a randomized order. The primary outcome was the percentage of time spent with SpO2 in the acceptable range of 90–95% during the DNP.ResultsOf the 265 included patients, 93% had been admitted for a medical pathology, the majority for acute respiratory failure (52%). There was no difference between the two periods in terms of DNP duration, sedation requirements, or ventilation parameters, but patients had more spontaneous breaths and lower peak airway pressures during the AV period (p < 0.001). The percentage of time spent with SpO2 in the acceptable range during DNPs was longer in the AV period than in the CV period (48 ± 37 vs. 43 ± 37, percentage of DNP period; p = 0.03). After adjustment, AV was associated with a higher number of DNPs carried out with SpO2 in the acceptable range (odds ratio, 1.82; 95% CI, 1.28 to 2.6; p = 0.001) and a lower incidence of blood oxygen desaturation ≤ 85% (adjusted odds ratio, 0.50; 95% CI, 0.30 to 0.85; p = 0.01).ConclusionAV appears to reduce the incidence and severity of blood oxygen desaturation during daily nursing procedures (DNPs) in comparison to CV.Trial registrationThis study was registered in clinical-trial.gov (NCT03176329) in June 2017.Graphical abstract
Highlights
Hypoxia is common during daily nursing procedures (DNPs) routinely performed on mechanically ventilated patients
Minute volume is adjusted according to End-tidal CO2 partial pressure (PetCO2) information or respiratory rate in passive or spontaneously breathing patients respectively and Fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP) are adjusted according to blood oxygen pulse saturation (SpO2) information
Before the DNP, Blood oxygen pulse saturation (SpO2) was significantly lower in automated ventilation mode (AV) than in conventional ventilation mode (CV) (95 ± 3% vs. 96 ± 3%, respectively; p < 0.001), whereas PaO2/FiO2 and SpO2/FiO2 were similar (p = 0.10 and 0.49, respectively)
Summary
Hypoxia is common during daily nursing procedures (DNPs) routinely performed on mechanically ventilated patients. Nursing procedures (DNPs) are routinely performed several times per day in the intensive care unit (ICU) and are crucial for patients’ hygiene and rehabilitation, and to prevent/treat complications due to immobilization [1,2,3,4]. These DNPs induce physiological changes with potential adverse effects, especially in patients undergoing mechanical ventilation (MV) [5,6,7,8,9]. The aim of our study was to compare the incidence and severity of blood oxygen desaturation during DNPs performed on patients ventilated in AV and in conventional ventilation mode (CV)
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