Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients

Background: Driving pressure (Delta P) and mechanical power (MP) are predictors of the risk of ventilation- induced lung injuries (VILI) in mechanically ventilated patients. INTELLiVENT-ASV(R) is a closed-loop ventilation mode that automatically adjusts respiratory rate and tidal volume, according to the patient's respiratory mechanics. Objectives: This prospective observational study investigated Delta P and MP (and also transpulmonary Delta P (Delta P-L) and MP (MPL) for a subgroup of patients) delivered by INTELLiVENT-ASV. Methods: Adult patients admitted to the ICU were included if they were sedated and met the criteria for a single lung condition (normal lungs, COPD, or ARDS). INTELLiVENT-ASV was used with default target settings. If PEEP was above 16 cmH2O, the recruitment strategy used transpulmonary pressure as a reference, and Delta P-L and MPL were computed. Measurements were made once for each patient. Results: Of the 255 patients included, 98 patients were classified as normal-lungs, 28 as COPD, and 129 as ARDS patients. The median Delta P was 8 (7-10), 10 (8-12), and 9 (8-11) cmH2O for normal-lungs, COPD, and ARDS patients, respectively. The median MP was 9.1 (4.9 - 13.5), 11.8 (8.6 - 16.5), and 8.8 (5.6 - 13.8) J/min for normal-lungs, COPD, and ARDS patients, respectively. For the 19 patients managed with transpulmonary pressure Delta P-L was 6 (4-7) cmH2O and MPL was 3.6 (3.1 - 4.4) J/min. Conclusions: In this short term observation study, INTELLiVENT-ASV selected Delta P and MP considered in safe ranges for lung protection. In a subgroup of ARDS patients, the combination of a recruitment strategy and INTELLiVENT-ASV resulted in an apparently safe Delta P-L and MPL. (C) 2019 Elsevier Inc. All rights reserved.