Abstract
BackgroundINTELLiVENT-ASV® (I-ASV) is a closed-loop ventilation mode that automatically controls the ventilation settings. Although a number of studies have reported the usefulness of I-ASV, the clinical situations in which it may be useful have not yet been clarified. We aimed to report our initial 3 years of experience using I-ASV, particularly the clinical conditions and the technical and organizational factors associated with its use. Furthermore, we evaluated the usefulness of I-ASV and determined the predictive factors for successful management with I-ASV.MethodsThis single-center, retrospective observational study included patients who were ventilated using the Hamilton G5® ventilator (Hamilton Medical AG, Rhäzüns, Switzerland) from January 2016 to December 2018. The patients were categorized into the “I-ASV success” group and “I-ASV failure” group (those receiving mechanical ventilation with I-ASV along with any other mode). Multivariate analysis was performed to identify factors associated with successful I-ASV management.ResultsOf the 189 patients, 135 (71.4%) were categorized into the I-ASV success group. In the I-ASV success group, the reasons for ICU admission included post-elective surgery (94.1%), post-emergent surgery (81.5%), and other medical reasons (55.6%). I-ASV failure was associated with a low P/F ratio (278 vs. 167, P = 0.0003) and high Acute Physiology and Chronic Health Evaluation (APACHE) II score (21 vs. 26, P < 0.0001). The main reasons for not using I-ASV included strong inspiratory effort and asynchrony. The APACHE II score was an independent predictive factor for successful management with I-ASV, with an odds ratio of 0.92 (95% confidential interval 0.87–0.96, P = 0.0006). The area under the receiver operating curve for the APACHE II score was 0.722 (cut-off: 24).ConclusionsIn this study, we found that 71.4% of the fully mechanically ventilated patients could be managed successfully with I-ASV. The APACHE II score was an independent factor that could help predict the successful management of I-ASV. To improve I-ASV management, it is necessary to focus on patient-ventilator interactions.
Highlights
INTELLiVENT-adaptive support ventilation (ASV)® (I-ASV) is a closed-loop ventilation mode that automatically controls the ventilation settings
We aimed to evaluate the factors which affected to I-ASV success from our initial 3 years of experience with this mode, the factors of clinical conditions and the technical and organizational factors associated with its use
I-ASV failure was associated with a high Acute Physiology and Chronic Health Evaluation (APACHE) II score (21 vs. 26, P < 0.0001), Sequential Organ Failure Assessment (SOFA) score (8 vs. 11, P < 0.0001), continuous renal replacement therapy (CRRT) (10.4% vs. 44.4%, P < 0.0001), use of vasopressors (52.6% vs. 70.4%, P = 0.034), use of morphine (5.2% vs. 27.8%, P < 0.0001), use of neuromuscular blockade (4.4% vs. 25.9%, P < 0.0001), type of intensive care unit (ICU) admission (P < 0.0001) and low P/F ratio (278 vs. 167, P = 0.0003)
Summary
INTELLiVENT-ASV® (I-ASV) is a closed-loop ventilation mode that automatically controls the ventilation settings. INTELLiVENT-ASV® (I-ASV) is a closed-loop ventilation mode that automatically adjusts the ventilator settings of adaptive support ventilation (ASV). It automatically controls the fraction of inspiratory oxygen (FIO2), percentage minute ventilation (%MV), and positive end-expiratory pressure (PEEP) by using end-tidal carbon dioxide tension (ETCO2), respiratory rate, and arterial oxygen saturation of pulse oximetry (SpO2) to keep the patient’s lung ventilated safely. Several studies have reported the usefulness of I-ASV [2,3,4,5,6,7], the clinical situations in which it should be used have not yet been clarified. There are few experienced facilities where IASV can be used, and its usage status and efficacy have not been reported
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