Background/Objectives: Attaining adequate oxygenation in critically ill patients undergoing invasive ventilation necessitates intense monitoring through pulse oximetry (SpO2) and frequent manual adjustments of ventilator settings like the fraction of inspired oxygen (FiO2) and the level of positive end-expiratory pressure (PEEP). Our aim was to compare the quality of oxygenation with the use of automated ventilation provided by INTELLiVENT-Adaptive Support Ventilation (ASV) vs. ventilation that is not automated, i.e., conventional pressure-controlled or pressure support ventilation. Methods: A substudy within a randomized crossover clinical trial in critically ill patients under invasive ventilation. The primary endpoint was the percentage of breaths in an optimal oxygenation zone, defined by predetermined levels of SpO2, FiO2, and PEEP. Secondary endpoints were the percentage of breaths in acceptable or critical oxygenation zones, the percentage of time spent in optimal, acceptable, and critical oxygenation zones, the number of manual interventions at the ventilator, and the number and duration of ventilator alarms related to oxygenation. Results: Of the 96 patients included in the parent study, 53 were eligible for this current subanalysis. Among them, 31 patients were randomized to start with automated ventilation, while 22 patients began with conventional ventilation. No significant differences were found in the percentage of breaths within the optimal zone between the two ventilation modes (median percentage of breaths during automated ventilation 19.4 [0.1-99.9]% vs. 25.3 [0.0-100.0]%; p = 0.963). Similarly, there were no differences in the percentage of breaths within the acceptable and critical zones, nor in the time spent in the three predefined oxygenation zones. Although the number of manual interventions was lower with automated ventilation, the number and duration of ventilator alarms were fewer with conventional ventilation. Conclusions: The quality of oxygenation with automated ventilation is not different from that with conventional ventilation. However, while automated ventilation comes with fewer manual interventions at the ventilator, it also comes with more ventilator alarms.

OBJECTIVES:To compare the number of alarms, interventions and nurses' acceptance of automated ventilation with INTELLiVENT-ASV versus conventional ventilation strategy in patients receiving postoperative ventilation after cardiac surgery. METHODS:This preplanned secondary analysis of the 'POSITiVE' randomized clinical trial compared INTELLiVENT-ASV (automated ventilation) with conventional ventilation in postoperative cardiac surgery patients. The number of critical alarms and manual ventilator interventions were compared during the first three hours of ventilation or until extubation. Nurses' acceptance was assessed using a Technology Acceptance Model 2-based questionnaire and a user acceptance score from 1 to 10. RESULTS:POSITiVE randomized 220 patients (109 to automated and 111 to conventional ventilation). The average number of critical alarms per monitoring hour was similar between the automated and conventional group (5.6 vs 5.7; p = 0.823). The automated group required fewer manual interventions per monitoring hour for both ventilation control (0.7 vs 1.9; p < 0.001) and alarm management (2.0 vs 2.8; p < 0.001). The automated ventilation mode scored higher for perceived usefulness (2.6 vs 2.1; p < 0.001) and user acceptance (8.0 vs 7.0; p < 0.001), but similar for perceived ease of use. CONCLUSIONS:Automated ventilation for postoperative cardiac surgery patients had similar alarm frequencies as conventional ventilation, but reduced the number of interventions and showed higher nurses' acceptance, indicating its potential to optimize patient care and reduce nurses' workload. IMPLICATIONS FOR CLINICAL PRACTICE:Our findings suggest that automated ventilation modes like INTELLiVENT-ASV can reduce the frequency of manual interventions and improve nurses' acceptance, which may help alleviate nurses' workload for postoperative cardiac surgery patients.

SummaryIntroductionHigh mechanical power is associated with mortality in patients who are critically ill and require invasive ventilation. It remains uncertain which components of mechanical power – volume, pressure or rate – increase mechanical power the most.MethodsWe conducted a post hoc analysis of a database containing individual patient data from three randomised clinical trials of ventilation in patients without acute respiratory distress syndrome. The primary endpoint was mechanical power. We used linear regression; double stratification to create subgroups of participants; and mediation analysis to assess the impact of changes in volumes, pressures and rates on mechanical power.ResultsA total of 1732 patients were included and analysed. The median (IQR [range]) mechanical power was 12.3 (9.3–17.1 [3.7–50.1]) J.min‐1. In linear regression, respiratory rate (36%) and peak pressure (51%) explained most of the increase in mechanical power. Increasing quintiles of peak pressure stratified on constant levels of respiratory rate resulted in higher risks of high mechanical power (relative risk 2.2 (95%CI 1.8–2.6), p < 0.01), while decreasing quintiles of respiratory rate stratified on constant levels of peak pressure resulted in lower risks of high mechanical power (relative risk 0.2 (95%CI 0.2–0.3), p < 0.01). Mediation analysis showed that a reduction in respiratory rate, with the increase in tidal volume, partially mediates an effect of reduction in mechanical power (average causal mediation effect ‐0.10, 95%CI ‐0.12 to ‐0.09, p < 0.01), but still with a direct effect of tidal volume on mechanical power (average direct effect 0.15, 95%CI 0.11–0.19, p < 0.01).DiscussionIn this cohort of patients without acute respiratory distress syndrome, pressure and respiratory rate were the most important determinants of mechanical power. The respiratory rate may be the most attractive ventilator setting to adjust when targeting a lower mechanical power.

BackgroundINTELLiVENT-adaptive support ventilation (ASV) is an automated closed-loop mode of invasive ventilation for use in critically ill patients. INTELLiVENT-ASV automatically adjusts, without the intervention of the caregiver, ventilator settings to achieve the lowest work and force of breathing. AimsThe aim of this case series is to describe the specific adjustments of INTELLiVENT-ASV in patients with acute hypoxemic respiratory failure, who were intubated for invasive ventilation. Study designWe describe three patients with severe acute respiratory distress syndrome (ARDS) because of COVID-19 who received invasive ventilation in our intensive care unit (ICU) in the first year of the COVID-19 pandemic. ResultsINTELLiVENT-ASV could be used successfully, but only after certain adjustments in the settings of the ventilator. Specifically, the high oxygen targets that are automatically chosen by INTELLiVENT-ASV when the lung condition 'ARDS' is ticked had to be lowered, and the titration ranges for positive end expiratory pressure (PEEP) and inspired oxygen fraction (FiO(2)) had to be narrowed. ConclusionThe challenges taught us how to adjust the ventilator settings so that INTELLiVENT-ASV could be used in successive COVID-19 ARDS patients, and we experienced the benefits of this closed-loop ventilation in clinical practice. Relevance to clinical practiceINTELLiVENT-ASV is attractive to use in clinical practice. It is safe and effective in providing lung-protective ventilation. A closely observing user always remains needed. INTELLiVENT-ASV has a strong potential to reduce the workload associated with ventilation because of the automated adjustments.

INTRODUCTION:Mechanical power of ventilation, a summary parameter reflecting the energy transferred from the ventilator to the respiratory system, has associations with outcomes. INTELLiVENT-Adaptive Support Ventilation is an automated ventilation mode that changes ventilator settings according to algorithms that target a low work-and force of breathing. The study aims to compare mechanical power between automated ventilation by means of INTELLiVENT-Adaptive Support Ventilation and conventional ventilation in critically ill patients. MATERIALS AND METHODS:International, multicenter, randomized crossover clinical trial in patients that were expected to need invasive ventilation > 24 hours. Patients were randomly assigned to start with a 3-hour period of automated ventilation or conventional ventilation after which the alternate ventilation mode was selected. The primary outcome was mechanical power in passive and active patients; secondary outcomes included key ventilator settings and ventilatory parameters that affect mechanical power. RESULTS:A total of 96 patients were randomized. Median mechanical power was not different between automated and conventional ventilation (15.8 [11.5-21.0] versus 16.1 [10.9-22.6] J/min; mean difference -0.44 (95%-CI -1.17 to 0.29) J/min; P = 0.24). Subgroup analyses showed that mechanical power was lower with automated ventilation in passive patients, 16.9 [12.5-22.1] versus 19.0 [14.1-25.0] J/min; mean difference -1.76 (95%-CI -2.47 to -10.34J/min; P < 0.01), and not in active patients (14.6 [11.0-20.3] vs 14.1 [10.1-21.3] J/min; mean difference 0.81 (95%-CI -2.13 to 0.49) J/min; P = 0.23). CONCLUSIONS:In this cohort of unselected critically ill invasively ventilated patients, automated ventilation by means of INTELLiVENT-Adaptive Support Ventilation did not reduce mechanical power. A reduction in mechanical power was only seen in passive patients. STUDY REGISTRATION:Clinicaltrials.gov (study identifier NCT04827927), April 1, 2021. URL OF TRIAL REGISTRY RECORD:https://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1.

Rationale: The positive end-expiratory pressure (PEEP) strategy in patients with coronavirus 2019 (COVID-19) acute respiratory distress syndrome (ARDS) remains debated. Most studies originate from the initial waves of the pandemic. Here we aimed to assess the impact of high PEEP/low FiO2 ventilation on outcomes during the second wave in the Netherlands. Methods: Retrospective observational study of invasively ventilated COVID-19 patients during the second wave. Patients were categorized based on whether they received high PEEP or low PEEP ventilation according to the ARDS Network tables. The primary outcome was ICU mortality, and secondary outcomes included hospital and 90-day mortality, duration of ventilation and length of stay, and the occurrence of kidney injury. Propensity matching was performed to correct for factors with a known relationship to ICU mortality. Results: This analysis included 790 COVID-ARDS patients. At ICU discharge, 32 (22.5%) out of 142 high PEEP patients and 254 (39.2%) out of 848 low PEEP patients had died (HR 0.66 [0.46-0.96]; P = 0.03). High PEEP was linked to improved secondary outcomes. Matched analysis did not change findings. Conclusions: High PEEP ventilation was associated with improved ICU survival in patients with COVID-ARDS.

One single-center randomized clinical trial showed that INTELLiVENT-adaptive support ventilation (ASV) is superior to conventional ventilation with respect to the quality of ventilation in post-cardiac surgery patients. Other studies showed that this automated ventilation mode reduces the number of manual interventions at the ventilator in various types of critically ill patients. In this multicenter study in patients post-cardiac surgery, we test the hypothesis that INTELLiVENT-ASV is superior to conventional ventilation with respect to the quality of ventilation. “POStoperative INTELLiVENT-adaptive support VEntilation in cardiac surgery patients II (POSITiVE II)” is an international, multicenter, two-group randomized clinical superiority trial. In total, 328 cardiac surgery patients will be randomized. Investigators screen patients aged > 18 years of age, scheduled for elective cardiac surgery, and expected to receive postoperative ventilation in the ICU for longer than 2 h. Patients either receive automated ventilation by means of INTELLiVENT-ASV or ventilation that is not automated by means of a conventional ventilation mode. The primary endpoint is quality of ventilation, defined as the proportion of postoperative ventilation time characterized by exposure to predefined optimal, acceptable, and critical (injurious) ventilatory parameters in the first two postoperative hours. One major secondary endpoint is ICU team staff workload, captured by the ventilator software collecting manual settings on alarms. Patient-centered endpoints include duration of postoperative ventilation and length of stay in ICU. POSITiVE II is the first international, multicenter, randomized clinical trial designed to confirm that POStoperative INTELLiVENT-ASV is superior to non-automated conventional ventilation and secondary to determine if this closed-loop ventilation mode reduces ICU team staff workload. The results of POSITiVE II will support intensive care teams in their choices regarding the use of automated ventilation in postoperative care of uncomplicated cardiac surgery patients. Clinicaltrials.gov NCT06178510 . Registered on December 4, 2023.

BACKGROUND:Lung protective ventilation is considered standard of care in the intensive care unit. However, modifying the ventilator settings can be challenging and is time consuming. Closed loop modes of ventilation are increasingly attractive for use in critically ill patients. With closed loop ventilation, settings that are typically managed by the ICU professionals are under control of the ventilator's algorithms.OBJECTIVES:To describe the effectiveness, safety, efficacy and workload with currently available closed loop ventilation modes.DESIGN:Systematic review of randomised clinical trials.DATA SOURCES:A comprehensive systematic search in PubMed, Embase and the Cochrane Central register of Controlled Trials search was performed in January 2023.ELIGIBILITY CRITERIA:Randomised clinical trials that compared closed loop ventilation with conventional ventilation modes and reported on effectiveness, safety, efficacy or workload.RESULTS:The search identified 51 studies that met the inclusion criteria. Closed loop ventilation, when compared with conventional ventilation, demonstrates enhanced management of crucial ventilator variables and parameters essential for lung protection across diverse patient cohorts. Adverse events were seldom reported. Several studies indicate potential improvements in patient outcomes with closed loop ventilation; however, it is worth noting that these studies might have been underpowered to conclusively demonstrate such benefits. Closed loop ventilation resulted in a reduction of various aspects associated with the workload of ICU professionals but there have been no studies that studied workload in sufficient detail.CONCLUSIONS:Closed loop ventilation modes are at least as effective in choosing correct ventilator settings as ventilation performed by ICU professionals and have the potential to reduce the workload related to ventilation. Nevertheless, there is a lack of sufficient research to comprehensively assess the overall impact of these modes on patient outcomes, and on the workload of ICU staff.

Lung–protective ventilation for invasively ventilated patients mimics normal breathing in which a low tidal volume is delivered at a specific respiratory rate with a limited inspiratory pressure on top of a sufficient level of positive end–expiratory pressure. It has been thoroughly demonstrated that despite being an expensive procedure, invasive ventilation when applied in a lung-protective way has a strong potential to improve the outcome of critically ill patients. However, implementing lung–protective ventilation has several challenges, including the fact that it can be quite time–consuming. One way to facilitate the use of lung–protective ventilation is to automate the settings involved with this strategy with closed–loop ventilation. In this review, we compare the epidemiology, ventilator management, and outcomes in critically ill ICU patients between middle–income countries and high–income countries and focus on the potentials and risks of closed–loop ventilation in middle–income countries.

Introduction The driving pressure (Δ P ) has an independent association with outcome in patients with acute respiratory distress syndrome (ARDS). INTELLiVENT-Adaptive Support Ventilation (ASV) is a closed-loop mode of ventilation that targets the lowest work and force of breathing. Aim To compare transpulmonary and respiratory system Δ P between closed-loop ventilation and conventional pressure controlled ventilation in patients with moderate-to-severe ARDS. Methods Single-center randomized cross-over clinical trial in patients in the early phase of ARDS. Patients were randomly assigned to start with a 4-h period of closed-loop ventilation or conventional ventilation, after which the alternate ventilation mode was selected. The primary outcome was the transpulmonary Δ P ; secondary outcomes included respiratory system Δ P , and other key parameters of ventilation. Results Thirteen patients were included, and all had fully analyzable data sets. Compared to conventional ventilation, with closed-loop ventilation the median transpulmonary Δ P with was lower (7.0 [5.0–10.0] vs. 10.0 [8.0–11.0] cmH 2 O, mean difference − 2.5 [95% CI − 2.6 to − 2.1] cmH 2 O; P = 0.0001). Inspiratory transpulmonary pressure and the respiratory rate were also lower. Tidal volume, however, was higher with closed-loop ventilation, but stayed below generally accepted safety cutoffs in the majority of patients. Conclusions In this small physiological study, when compared to conventional pressure controlled ventilation INTELLiVENT-ASV reduced the transpulmonary Δ P in patients in the early phase of moderate-to-severe ARDS. This closed-loop ventilation mode also led to a lower inspiratory transpulmonary pressure and a lower respiratory rate, thereby reducing the intensity of ventilation. Trial registration Clinicaltrials.gov, NCT03211494, July 7, 2017. https://clinicaltrials.gov/ct2/show/NCT03211494?term=airdrop&draw=2&rank=1 .

Since 2000, following the publication of the ARMA study, 1 Brower RG Matthay MA Morris A Schoenfeld D Thompson BT Wheeler A Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342: 1301-1308 Crossref PubMed Scopus (10333) Google Scholar low tidal volume (VT) ventilation (LTV) has been the standard of care for patients with acute respiratory distress syndrome (ARDS). LTV often refers to ventilation with VT of 6·0 mL/kg predicted bodyweight, based on what was compared in the landmark ARMA study (ventilation with VT of 6·0 mL/kg vs 12·0 mL/kg predicted bodyweight resulting in a mortality rate of 31% vs 40%). Several—mostly observational—studies have since confirmed the benefits of ventilation with VT of 6·0 mL/kg predicted bodyweight, including in invasively ventilated patients with COVID-19. 2 Botta M Tsonas AM Pillay J et al. Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study. Lancet Respir Med. 2021; 9: 139-148 Summary Full Text Full Text PDF PubMed Scopus (150) Google Scholar Ultra-low tidal volume ventilation for COVID-19-related ARDS in France (VT4COVID): a multicentre, open-label, parallel-group, randomised trialIn patients with moderate-to-severe COVID-19-related ARDS, there was no significant difference with ULTV compared with LTV in the composite score based on mortality and ventilator-free days among patients alive at day 60. These findings do not support the systematic use of ULTV in patients with COVID-19-related ARDS. Full-Text PDF

Dear Editor, We would like to thank Dr Bruitman-Kruizinga and Dr Schultz for their interest in our study1 and their important comments. The authors postulate that measuring mechanical power from continuous recordings in our study yielded a higher mechanical power when compared to previous studies, and they propose using the more widely applied simplified formula:2 ![Formula][1] We would like to emphasize that this mathematical approximation has only been validated during volume controlled mechanical ventilation,3,4 and some authors have suggested alternative formulas.3⇓⇓-6 Most importantly, the above formula has not been validated in patients receiving adaptive support ventilation (ASV) or other pressure-regulated modes of ventilation such as adaptive pressure ventilation (APV) (which were the 2 ventilator modes utilized in the initial study). In response to the comments by Dr Bruitman-Kruizinga and Dr Schultz, we calculated mechanical power using this formula, which was 21.8 [interquartile range [IQR] 18.9–31.8] J/min in ASV and 22.3 [IQR 19.2–29.8] J/min in … Correspondence: Elias Baedorf-Kassis MD. E-mail: Enbaedor{at}bidmc.harvard.edu [1]: /embed/graphic-1.gif

Background INTELLiVENT–Adaptive Support Ventilation (ASV) is a fully automated closed-loop mode of ventilation for use in critically ill patients. Evidence for benefit of INTELLiVENT–ASV in comparison to ventilation that is not fully automated with regard to duration of ventilation and quality of breathing is largely lacking. We test the hypothesis that INTELLiVENT–ASV shortens time spent on a ventilator and improves the quality of breathing. Methods The “Effects of Automated Closed–loop VenTilation versus Conventional Ventilation on Duration and Quality of Ventilation” (ACTiVE) study is an international, multicenter, two-group randomized clinical superiority trial. In total, 1200 intensive care unit (ICU) patients with an anticipated duration of ventilation of > 24 h will be randomly assigned to one of the two ventilation strategies. Investigators screen patients aged 18 years or older at start of invasive ventilation in the ICU. Patients either receive automated ventilation by means of INTELLiVENT–ASV, or ventilation that is not automated by means of a conventional ventilation mode. The primary endpoint is the number of days free from ventilation and alive at day 28; secondary endpoints are quality of breathing using granular breath-by-breath analysis of ventilation parameters and variables in a time frame of 24 h early after the start of invasive ventilation, duration of ventilation in survivors, ICU and hospital length of stay (LOS), and mortality rates in the ICU and hospital, and at 28 and 90 days. Discussion ACTiVE is one of the first randomized clinical trials that is adequately powered to compare the effects of automated closed-loop ventilation versus conventional ventilation on duration of ventilation and quality of breathing in invasively ventilated critically ill patients. The results of ACTiVE will support intensivist in their choices regarding the use of automated ventilation. Trial registration ACTiVE is registered in clinicaltrials.gov (study identifier: NCT04593810 ) on 20 October 2020.

Objectives:. The aim of this pilot study was to compare the amount of “mechanical power of ventilation” under adaptive support ventilation with nonautomated pressure-controlled ventilation. Design:. Single-center, observational prospective pilot study adjoining unitwide implementation of adaptive support ventilation in our department. Setting:. The ICU of a nonacademic teaching hospital in the Netherlands. Patients:. Twenty-four passive invasively ventilated critically ill patients expected to need of invasive ventilation beyond the following calendar day. Measurements and Main Results:. In patients under adaptive support ventilation, only positive end-expiratory pressure and Fio2 were set by the caregivers—all other ventilator settings were under control of the ventilator; in patients under pressure-controlled ventilation, maximum airway pressure (Pmax), positive end-expiratory pressure, Fio2, and respiratory rate were set by the caregivers. Mechanical power of ventilation was calculated three times per day. Compared with pressure-controlled ventilation, mechanical power of ventilation with adaptive support ventilation was lower (15.1 [10.5–25.7] vs 22.9 [18.7–28.8] J/min; p = 0.04). Tidal volume was not different, but Pmax (p = 0.012) and respiratory rate (p = 0.012) were lower with adaptive support ventilation. Conclusions:. This study suggests adaptive support ventilation may have benefits compared with pressure-controlled ventilation with respect to the mechanical power of ventilation transferred from the ventilator to the respiratory system in passive invasively ventilated critically ill patients. The difference in mechanical power of ventilation is not a result of a difference in tidal volume, but the reduction in applied pressures and respiratory rate. The findings of this observational pilot study need to be confirmed in a larger, preferably randomized clinical trial.

Introduction: INTELLiVENT-Adaptive Support Ventilation (INTELLiVENT-ASV), an advanced closed-loop ventilation mode for use in intensive care unit (ICU) patients, is equipped with algorithms that automatically adjust settings on the basis of physiologic signals and patient's activity. Here we describe its effectiveness, safety, and efficacy in various types of ICU patients.Areas covered: A systematic search conducted in MEDLINE, EMBASE, the Cochrane Central register of Controlled Trials (CENTRAL), and in Google Scholar identified 10 randomized clinical trials.Expert opinion: Studies suggest INTELLiVENT-ASV to be an effective automated mode with regard to the titrations of tidal volume, airway pressure, and oxygen. INTELLiVENT-ASV is as safe as conventional modes. However, thus far studies have not shown INTELLiVENT-ASV to be superior to conventional modes with regard to duration of ventilation and other patient-centered outcomes. Future studies are needed to test its efficacy.

Background: The SpO(2)/FiO(2) is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO(2)/FiO(2) for mortality in patients with ARDS due to COVID-19. Methods: This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID-19. The primary endpoint was 28-day mortality. Results: In 869 invasively ventilated patients, 28-day mortality was 30.1%. The SpO(2)/FiO(2) on day 1 had no prognostic value. The SpO(2)/FiO(2) on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO(2)/FiO(2) on day 2 (OR, 0.66 [95%-CI 0.46-0.96]) and on day 3 (OR, 0.70 [95%-CI 0.51-0.96]) were associated with 28-day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76-0.79]). The measured PaO2/FiO(2) and the PaO2/FiO(2) calculated from SpO(2)/FiO(2) were strongly correlated (Spearman's r = 0.79). Conclusions: In this cohort of patients with ARDS due to COVID-19, the SpO(2)/FiO(2) on day 2 and day 3 are independently associated with and have prognostic capacity for 28-day mortality. The SpO(2)/FiO(2) is a useful metric for risk stratification in invasively ventilated COVID-19 patients. (C) 2021 The Authors. Published by Elsevier Inc.

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.

Introduction: INTELLiVENT-ASV, a fully-automated ventilatory mode, controls key elements of lung-protective ventilation. The 'mechanical power of ventilation' (MP) summarizes these elements, and has an association with outcome in ARDS patients. Aims: To compare MP under INTELLiVENT-ASV vs conventional ventilation in COVID-19 ARDS patients. We hypothesized INTELLiVENT-ASV to deliver ventilation with less MP. Methods: Observational study in COVID-19 ARDS patients in 2 ICUs in the Netherlands. Endpoints were MP (primary) and other ventilation parameters, including tidal volume (VT), driving pressure (ΔP), respiratory rate (RR), PEEP and Pmax, calculated and collected at 4 time points, before and after a change from conventional ventilation to INTELLiVENT-ASV. Results: In 51 patients, median MP dropped after the change to INTELLiVENT-ASV, from 24 J/min (IQR 17-33) to 18 J/min (IQR 12-22) (mean difference of -7.1 J/min (95% CI -8.4 to -5.9; P < 0.0001). With that change, median VT increased, but ΔP, RR and Pmax decreased. PEEP did not change (figure). Conclusions: In this cohort of COVID-19 ARDS patients, fully-automated ventilation with INTELLiVENT-ASV delivered ventilation with less MP. This was due to a higher but still acceptable VT, and to a lower ΔP, Pmax and RR. The effect on patient-outcomes need to be studied in future trials.

Background: INTELLiVENT-ASV, an advanced closed-loop ventilatory mode for ICU patients, is equipped with algorithms that automatically adjust ventilator settings on the bases of physiologic signals and patient’s activity. Aim: To describe its effectiveness, safety, and efficacy in various types of ICU patients. Methods: Systematic search conducted in MEDLINE, EMBASE, the Cochrane Central register of Controlled Trials (CENTRAL), and in Google Scholar. Searches in trial registries to identify yet unpublished or ongoing studies. Results: The searches identified 10 RCTs, 4 in postoperative patients and 6 in mixed ICU populations, including patients with ARDS, patients with sepsis or shock. INTELLiVENT–ASV is an effective automated mode with regard to VT titrations and FiO2 and PEEP titrations. In none of the studies safety issues were reported with use of INTELLiVENT–ASV. Thus far, studies have not shown superiority of INTELLiVENT–ASV with regard to duration of ventilation and other patient–centered outcomes. Conclusions: This systematic review shows INTELLiVENT–ASV to be an effective and safe ventilatory mode. Future studies are needed to test its efficacy.