Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial

Laura A. Buiteman-Kruizinga; Ary Serpa Neto; Michela Botta; Stephanie S. List; Ben H. de Boer; Patricia van Velzen; Philipp Karl Bühler; Pedro D. Wendel Garcia; Marcus J. Schultz; Pim L. J. van der Heiden; Frederique Paulus; the INTELLiPOWER-investigators

doi:10.1371/journal.pone.0307155

Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial

Laura A. Buiteman-Kruizinga, Ary Serpa Neto, Michela Botta, Stephanie S. List, Ben H. de Boer, Patricia van Velzen, Philipp Karl Bühler, Pedro D. Wendel Garcia, Marcus J. Schultz, Pim L. J. van der Heiden, Frederique Paulus, the INTELLiPOWER-investigators

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Abstract

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

Original language	English
Article number	e0307155
Number of pages	18
Journal	PLoS ONE
Volume	19
Issue number	7
DOIs	https://doi.org/10.1371/journal.pone.0307155
Publication status	Published - Jul 2024

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Buiteman-Kruizinga, L. A., Neto, A. S., Botta, M., List, S. S., de Boer, B. H., van Velzen, P., Bühler, P. K., Wendel Garcia, P. D., Schultz, M. J., van der Heiden, P. L. J., Paulus, F., & the INTELLiPOWER-investigators (2024). Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial. PLoS ONE , 19(7), Article e0307155. https://doi.org/10.1371/journal.pone.0307155

@article{20d98d1eeeae491eb1f790587460e538,

title = "Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial",

abstract = "IntroductionMechanical 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 methodsInternational, 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.ResultsA 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).ConclusionsIn 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 registrationClinicaltrials.gov (study identifier NCT04827927), April 1, 2021URL of trial registry recordhttps://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1",

author = "Buiteman-Kruizinga, {Laura A.} and Neto, {Ary Serpa} and Michela Botta and List, {Stephanie S.} and {de Boer}, {Ben H.} and {van Velzen}, Patricia and B{\"u}hler, {Philipp Karl} and {Wendel Garcia}, {Pedro D.} and Schultz, {Marcus J.} and {van der Heiden}, {Pim L. J.} and Frederique Paulus and {the INTELLiPOWER-investigators} and Appel, {Rik J.A.} and {van den Berg}, Amanda and Bierlee, {Marjolein C.W.M.}",

note = "With supplementary files. ",

year = "2024",

month = jul,

doi = "10.1371/journal.pone.0307155",

language = "English",

volume = "19",

journal = "PLoS ONE ",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "7",

}

Buiteman-Kruizinga, LA, Neto, AS, Botta, M, List, SS, de Boer, BH, van Velzen, P, Bühler, PK, Wendel Garcia, PD, Schultz, MJ, van der Heiden, PLJ, Paulus, F & the INTELLiPOWER-investigators 2024, 'Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial', PLoS ONE , vol. 19, no. 7, e0307155. https://doi.org/10.1371/journal.pone.0307155

TY - JOUR

T1 - Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial

AU - Buiteman-Kruizinga, Laura A.

AU - Neto, Ary Serpa

AU - Botta, Michela

AU - List, Stephanie S.

AU - de Boer, Ben H.

AU - van Velzen, Patricia

AU - Bühler, Philipp Karl

AU - Wendel Garcia, Pedro D.

AU - Schultz, Marcus J.

AU - van der Heiden, Pim L. J.

AU - Paulus, Frederique

AU - the INTELLiPOWER-investigators

AU - Appel, Rik J.A.

AU - van den Berg, Amanda

AU - Bierlee, Marjolein C.W.M.

N1 - With supplementary files.

PY - 2024/7

Y1 - 2024/7

N2 - IntroductionMechanical 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 methodsInternational, 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.ResultsA 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).ConclusionsIn 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 registrationClinicaltrials.gov (study identifier NCT04827927), April 1, 2021URL of trial registry recordhttps://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1

AB - IntroductionMechanical 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 methodsInternational, 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.ResultsA 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).ConclusionsIn 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 registrationClinicaltrials.gov (study identifier NCT04827927), April 1, 2021URL of trial registry recordhttps://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1

U2 - 10.1371/journal.pone.0307155

DO - 10.1371/journal.pone.0307155

M3 - Article

C2 - 39078857

AN - SCOPUS:85199940935

SN - 1932-6203

VL - 19

JO - PLoS ONE

JF - PLoS ONE

IS - 7

M1 - e0307155

ER -

Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial

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