Closed‐loop ventilation in COVID‐19 patients with acute hypoxemic respiratory failure—A case series

• Published in: Nursing in critical care Vol. 29; no. 1; pp. 219 - 225
• Main Authors: Buiteman‐Kruizinga, Laura A., Heiden, Pim L. J., Paulus, Frederique, Schultz, Marcus J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-01-2024; Wiley Subscription Services, Inc
• Subjects: ARDS; automated ventilation; Automation; Clinical medicine; closed‐loop ventilation; COVID-19; Critical care; mechanical ventilation; Respiratory failure; Ventilators; COVID-19; automated ventilation; closed-loop ventilation; mechanical ventilation; ARDS
• ISSN: 1362-1017; 1478-5153
• DOI: 10.1111/nicc.12924

Background
INTELLiVENT‐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.
Aims
The 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 design
We 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.
Results
INTELLiVENT‐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 (FiO2) had to be narrowed.
Conclusions
The 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 practice
INTELLiVENT‐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.