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Closed-Loop Versus Conventional Mechanical Ventilation in COVID-19 ARDS.
Wendel Garcia, Pedro David; Hofmaenner, Daniel Andrea; Brugger, Silvio D; Acevedo, Claudio T; Bartussek, Jan; Camen, Giovanni; Bader, Patrick Raphael; Bruellmann, Gregor; Kattner, Johannes; Ganter, Christoph; Schuepbach, Reto Andreas; Buehler, Philipp Karl.
  • Wendel Garcia PD; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland.
  • Hofmaenner DA; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland.
  • Brugger SD; Division of Infectious Diseases, 27243University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
  • Acevedo CT; Division of Infectious Diseases, 27243University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
  • Bartussek J; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland.
  • Camen G; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland.
  • Bader PR; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland.
  • Bruellmann G; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland.
  • Kattner J; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland.
  • Ganter C; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland.
  • Schuepbach RA; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland.
  • Buehler PK; Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland.
J Intensive Care Med ; 36(10): 1184-1193, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1261246
Semantic information from SemMedBD (by NLM)
1. Mechanical ventilation TREATS Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2
Subject
Mechanical ventilation
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TREATS
Object
Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2
2. Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2 PROCESS_OF Patients
Subject
Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2
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PROCESS_OF
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Patients
3. Hospital LOCATION_OF C0033522
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Hospital
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LOCATION_OF
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C0033522
4. Assisted breathing compared_with Mechanical ventilation
Subject
Assisted breathing
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compared_with
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Mechanical ventilation
5. Mechanical ventilation TREATS Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2
Subject
Mechanical ventilation
Predicate
TREATS
Object
Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2
6. Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2 PROCESS_OF Patients
Subject
Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2
Predicate
PROCESS_OF
Object
Patients
7. Hospitals, University LOCATION_OF Prospective Studies
Subject
Hospitals, University
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LOCATION_OF
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Prospective Studies
8. Assisted breathing compared_with Mechanical ventilation
Subject
Assisted breathing
Predicate
compared_with
Object
Mechanical ventilation
ABSTRACT

BACKGROUND:

Lung-protective ventilation is key in bridging patients suffering from COVID-19 acute respiratory distress syndrome (ARDS) to recovery. However, resource and personnel limitations during pandemics complicate the implementation of lung-protective protocols. Automated ventilation modes may prove decisive in these settings enabling higher degrees of lung-protective ventilation than conventional modes.

METHOD:

Prospective study at a Swiss university hospital. Critically ill, mechanically ventilated COVID-19 ARDS patients were allocated, by study-blinded coordinating staff, to either closed-loop or conventional mechanical ventilation, based on mechanical ventilator availability. Primary outcome was the overall achieved percentage of lung-protective ventilation in closed-loop versus conventional mechanical ventilation, assessed minute-by-minute, during the initial 7 days and overall mechanical ventilation time. Lung-protective ventilation was defined as the combined target of tidal volume <8 ml per kg of ideal body weight, dynamic driving pressure <15 cmH2O, peak pressure <30 cmH2O, peripheral oxygen saturation ≥88% and dynamic mechanical power <17 J/min.

RESULTS:

Forty COVID-19 ARDS patients, accounting for 1,048,630 minutes (728 days) of cumulative mechanical ventilation, allocated to either closed-loop (n = 23) or conventional ventilation (n = 17), presenting with a median paO2/ FiO2 ratio of 92 [72-147] mmHg and a static compliance of 18 [11-25] ml/cmH2O, were mechanically ventilated for 11 [4-25] days and had a 28-day mortality rate of 20%. During the initial 7 days of mechanical ventilation, patients in the closed-loop group were ventilated lung-protectively for 65% of the time versus 38% in the conventional group (Odds Ratio, 1.79; 95% CI, 1.76-1.82; P < 0.001) and for 45% versus 33% of overall mechanical ventilation time (Odds Ratio, 1.22; 95% CI, 1.21-1.23; P < 0.001).

CONCLUSION:

Among critically ill, mechanically ventilated COVID-19 ARDS patients during an early highpoint of the pandemic, mechanical ventilation using a closed-loop mode was associated with a higher degree of lung-protective ventilation than was conventional mechanical ventilation.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2021 Document Type: Article Affiliation country: 08850666211024139

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2021 Document Type: Article Affiliation country: 08850666211024139