Randomized crossover trial to compare driving pressures in a closed-loop and a conventional mechanical ventilation mode in pediatric patients
Pediatric Pulmonology, cilt.56, sa.9, ss.3035-3043, 2021 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 56 Sayı: 9
- Basım Tarihi: 2021
- Doi Numarası: 10.1002/ppul.25561
- Dergi Adı: Pediatric Pulmonology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
- Sayfa Sayıları: ss.3035-3043
- Anahtar Kelimeler: adaptive support ventilation (ASV), closed-loop, driving pressure (DP), mechanical ventilation, pediatric intensive care unit (PICU)
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Introduction: In mechanically ventilated patients, driving pressure (ΔP) represents the dynamic stress applied to the respiratory system and is related to ICU mortality. An evolution of the Adaptive Support Ventilation algorithm (ASV® 1.1) minimizes inspiratory pressure in addition to minimizing the work of breathing. We hypothesized that ASV 1.1 would result in lower ΔP than the ΔP measured in APV-CMV (controlled mandatory ventilation with adaptive pressure ventilation) mode with physician-tailored settings. The aim of this randomized crossover trial was therefore to compare ΔP in ASV 1.1 with ΔP in physician-tailored APV-CMV mode. Methods: Pediatric patients admitted to the PICU with heterogeneous-lung disease were enrolled if they were ventilated invasively with no detectable respiratory effort, hemodynamic instability, or significant airway leak around the endotracheal tube. We compared two 60-min periods of ventilation in APV-CMV and ASV 1.1, which were determined by randomization and separated by 30-min washout periods. Settings were adjusted to reach the same minute ventilation in both modes. ΔP was calculated as the difference between plateau pressure and total PEEP measured using end-inspiratory and end-expiratory occlusions, respectively. Results: There were 26 patients enrolled with a median age of 16 (9−25 [IQR]) months. The median ΔP for these patients was 10.4 (8.5−12.1 [IQR]) and 12.4 (10.5−15.3 [IQR]) cmH2O in the ASV 1.1 and APV-CMV periods, respectively (p <.001). The median tidal volume (VT) selected by the ASV 1.1 algorithm was 6.4 (5.1−7.3 [IQR]) ml/kg and RR was 41 (33 50 [IQR]) b/min, whereas the median of the same values for the APV-CMV period was 7.9 (6.8−8.3 [IQR]) ml/kg and 31 (26−41[IQR]) b/min, respectively. In both ASV 1.1 and APV-CMV modes, the highest ΔP was used to ventilate those patients with restrictive lung conditions at baseline. Conclusion: In this randomized crossover trial, ΔP in ASV 1.1 was lower compared to ΔP in physician-tailored APV-CMV mode in pediatric patients with different lung conditions. The use of ASV 1.1 may therefore result in continued, safe ventilation in a heterogeneous pediatric patient group.