TY - JOUR
T1 - A pilot prospective study on closed loop controlled ventilation and oxygenation in ventilated children during the weaning phase
AU - Jouvet, Philippe
AU - Eddington, Allen
AU - Payen, Valérie
AU - Bordessoule, Alice
AU - Emeriaud, Guillaume
AU - Gasco, Ricardo L.
AU - Wysocki, Marc
N1 - Funding Information:
Intellivent®® and an S1 respirator were provided for research purposes by Hamilton Medical. PJ was invited twice to present the results of the clinical research on IntelliVent®® at international meetings organised by Hamilton Medical without any honoraria. PJ also has a respirator Servo-i and an Evita XL, provided for research purposes by Maquet Medical (Solna, Sweden) and Drager Medical (Lübeck, Germany), respectively. PJ receives a research salary from the Fonds de Recherche du Québec - Santé in respiratory critical care. PJ’s research on clinical decision support systems is funded by a public grant from the Natural Sciences and Engineering Research Council of Canada. MW was the director of the Research and Development department of Hamilton Medical until the end of 2011. MW co-shares a patent on IntelliVent®® (WO/2007/085110 and WO/2007/085108). RLG is a medical research engineer employed by Hamilton Medical. The other authors declare they have no competing interests. These declarations do not mean that the interpretation of data and presentation of information was influenced by these relationships. This is fair research in collaboration with industry to obtain a final product helpful for children.
PY - 2012/5/16
Y1 - 2012/5/16
N2 - Introduction: The present study is a pilot prospective safety evaluation of a new closed loop computerised protocol on ventilation and oxygenation in stable, spontaneously breathing children weighing more than 7 kg, during the weaning phase of mechanical ventilation.Methods: Mechanically ventilated children ready to start the weaning process were ventilated for five periods of 60 minutes in the following order: pressure support ventilation, adaptive support ventilation (ASV), ASV plus a ventilation controller (ASV-CO 2), ASV-CO 2 plus an oxygenation controller (ASV-CO 2-O 2) and pressure support ventilation again. Based on breath-by-breath analysis, the percentage of time with normal ventilation as defined by a respiratory rate between 10 and 40 breaths/minute, tidal volume > 5 ml/kg predicted body weight and end-tidal CO 2 between 25 and 55 mmHg was determined. The number of manipulations and changes on the ventilator were also recorded.Results: Fifteen children, median aged 45 months, were investigated. No adverse event and no premature protocol termination were reported. ASV-CO 2 and ASV-CO 2-O 2 kept the patients within normal ventilation for, respectively, 94% (91 to 96%) and 94% (87 to 96%) of the time. The tidal volume, respiratory rate, peak inspiratory airway pressure and minute ventilation were equivalent for all modalities, although there were more automatic setting changes in ASV-CO 2 and ASV-CO 2-O 2. Positive end-expiratory pressure modifications by ASV-CO 2-O 2 require further investigation.Conclusion: Over the short study period and in this specific population, ASV-CO 2 and ASV-CO 2-O 2 were safe and kept the patient under normal ventilation most of the time. Further research is needed, especially for positive end-expiratory pressure modifications by ASV-CO 2-O 2.Trial registration: ClinicalTrials.gov: NCT01095406.
AB - Introduction: The present study is a pilot prospective safety evaluation of a new closed loop computerised protocol on ventilation and oxygenation in stable, spontaneously breathing children weighing more than 7 kg, during the weaning phase of mechanical ventilation.Methods: Mechanically ventilated children ready to start the weaning process were ventilated for five periods of 60 minutes in the following order: pressure support ventilation, adaptive support ventilation (ASV), ASV plus a ventilation controller (ASV-CO 2), ASV-CO 2 plus an oxygenation controller (ASV-CO 2-O 2) and pressure support ventilation again. Based on breath-by-breath analysis, the percentage of time with normal ventilation as defined by a respiratory rate between 10 and 40 breaths/minute, tidal volume > 5 ml/kg predicted body weight and end-tidal CO 2 between 25 and 55 mmHg was determined. The number of manipulations and changes on the ventilator were also recorded.Results: Fifteen children, median aged 45 months, were investigated. No adverse event and no premature protocol termination were reported. ASV-CO 2 and ASV-CO 2-O 2 kept the patients within normal ventilation for, respectively, 94% (91 to 96%) and 94% (87 to 96%) of the time. The tidal volume, respiratory rate, peak inspiratory airway pressure and minute ventilation were equivalent for all modalities, although there were more automatic setting changes in ASV-CO 2 and ASV-CO 2-O 2. Positive end-expiratory pressure modifications by ASV-CO 2-O 2 require further investigation.Conclusion: Over the short study period and in this specific population, ASV-CO 2 and ASV-CO 2-O 2 were safe and kept the patient under normal ventilation most of the time. Further research is needed, especially for positive end-expiratory pressure modifications by ASV-CO 2-O 2.Trial registration: ClinicalTrials.gov: NCT01095406.
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U2 - 10.1186/cc11343
DO - 10.1186/cc11343
M3 - Article
C2 - 22591622
AN - SCOPUS:84861864666
SN - 1364-8535
VL - 16
JO - Critical Care
JF - Critical Care
IS - 3
M1 - R85
ER -