Fully automated postoperative ventilation in cardiac surgery patients: a randomised clinical trial

Ashley J.R. De Bie; Ary Serpa Neto; David M. van Meenen; Arthur R. Bouwman; Arnout N. Roos; Joost R. Lameijer; Erik H.M. Korsten; Marcus J. Schultz; Alexander J.G.H. Bindels

doi:10.1016/j.bja.2020.06.037

Fully automated postoperative ventilation in cardiac surgery patients: a randomised clinical trial

Ashley J.R. De Bie (Corresponding author), Ary Serpa Neto, David M. van Meenen, Arthur R. Bouwman, Arnout N. Roos, Joost R. Lameijer, Erik H.M. Korsten, Marcus J. Schultz, Alexander J.G.H. Bindels

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Ensuring that lung-protective ventilation is achieved at scale is challenging in perioperative practice. Fully automated ventilation may be more effective in delivering lung-protective ventilation. Here, we compared automated lung-protective ventilation with conventional ventilation after elective cardiac surgery in haemodynamically stable patients. Methods: In this single-centre investigator-led study, patients were randomly assigned at the end of cardiac surgery to receive either automated (adaptive support ventilation) or conventional ventilation. The primary endpoint was the proportion of postoperative ventilation time characterised by exposure to predefined optimal, acceptable, and critical (injurious) ventilatory parameters in the first three postoperative hours. Secondary outcomes included severe hypoxaemia (SpO₂ <85%) and resumption of spontaneous breathing. Data are presented as mean (95% confidence intervals [CIs]). Results: We randomised 220 patients (30.4% females; age: 62–76 yr). Subjects randomised to automated ventilation (n=109) spent a 29.7% (95% CI: 22.1–37.4) higher mean proportion of postoperative ventilation time receiving optimal postoperative ventilation after surgery (P<0.001) compared with subjects receiving conventional postoperative ventilation (n=111). Automated ventilation also reduced the proportion of postoperative ventilation time that subjects were exposed to injurious ventilatory settings by 2.5% (95% CI: 1–4; P=0.003). Severe hypoxaemia was less likely in subjects randomised to automated ventilation (risk ratio: 0.26 [0.22–0.31]; P<0.01). Subjects resumed spontaneous breathing more rapidly when randomised to automated ventilation (hazard ratio: 1.38 [1.05–1.83]; P=0.03). Conclusions: Fully automated ventilation in haemodynamically stable patients after cardiac surgery optimised lung-protective ventilation during postoperative ventilation, with fewer episodes of severe hypoxaemia and an accelerated resumption of spontaneous breathing. Clinical trial registration: NCT03180203.

Original language	English
Pages (from-to)	739-749
Number of pages	11
Journal	British Journal of Anaesthesia
Volume	125
Issue number	5
DOIs	https://doi.org/10.1016/j.bja.2020.06.037
Publication status	Published - Nov 2020

Funding

AJRDB's PhD research is funded by the Impuls-2 project, a collaboration of Catharina Hospital Eindhoven, Eindhoven University of Technology, and Philips Research. In 2018, AJRDB and MJS attended a workshop organised by Hamilton, in which expenses for lodging were covered for all invited experts, participants from abroad had their travel expenses reimbursed, and speakers received a speaker's fee of CHF 800-. ARB received travel support from CSL Behring to visit Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) 2015. ARB is clinical consultant for Philips Research in Eindhoven, Netherlands, since January 2016. EHMK is clinical consultant for Philips Research since January 2016. The other authors declare that they have no conflicts of interest. The authors are indebted to all multidisciplinary team members in the study centre for their enthusiastic support and following the study interventions. This investigator-initiated research was sponsored by the Catharina Hospital Eindhoven, Amsterdam University Medical Centers, and Hospital Israelita Albert Einstein. The sponsors had no role in the study design; collection, analysis, and interpretation of data; writing of this paper, and the decision to submit this paper for publication. The authors thank the following collaborators from Catharina Hospital Eindhoven: J. J. M. Verberne, A. H. M. van Straten, P. Kuijpers, E. F. E. Wenstedt, P. Julien, W. Leszczynski-Hordijk, J. J. Dijkmans, E. P. C. Oosterbos, and S. Harms.

Keywords

automated ventilation
cardiac surgery
intensive care unit
lung protection
mechanical ventilation
postoperative ventilation
protective ventilation
Automation
Humans
Middle Aged
Cardiac Surgical Procedures/instrumentation
Male
Treatment Outcome
Positive-Pressure Respiration
Postoperative Complications/epidemiology
Endpoint Determination
Respiration, Artificial/instrumentation
Female
Aged
Postoperative Care/instrumentation
Respiratory Function Tests

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10.1016/j.bja.2020.06.037

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@article{cec3eb6c92e7441ebae442aeb484cd87,

title = "Fully automated postoperative ventilation in cardiac surgery patients: a randomised clinical trial",

abstract = "Background: Ensuring that lung-protective ventilation is achieved at scale is challenging in perioperative practice. Fully automated ventilation may be more effective in delivering lung-protective ventilation. Here, we compared automated lung-protective ventilation with conventional ventilation after elective cardiac surgery in haemodynamically stable patients. Methods: In this single-centre investigator-led study, patients were randomly assigned at the end of cardiac surgery to receive either automated (adaptive support ventilation) or conventional ventilation. The primary endpoint was the proportion of postoperative ventilation time characterised by exposure to predefined optimal, acceptable, and critical (injurious) ventilatory parameters in the first three postoperative hours. Secondary outcomes included severe hypoxaemia (SpO2 <85%) and resumption of spontaneous breathing. Data are presented as mean (95% confidence intervals [CIs]). Results: We randomised 220 patients (30.4% females; age: 62–76 yr). Subjects randomised to automated ventilation (n=109) spent a 29.7% (95% CI: 22.1–37.4) higher mean proportion of postoperative ventilation time receiving optimal postoperative ventilation after surgery (P<0.001) compared with subjects receiving conventional postoperative ventilation (n=111). Automated ventilation also reduced the proportion of postoperative ventilation time that subjects were exposed to injurious ventilatory settings by 2.5% (95% CI: 1–4; P=0.003). Severe hypoxaemia was less likely in subjects randomised to automated ventilation (risk ratio: 0.26 [0.22–0.31]; P<0.01). Subjects resumed spontaneous breathing more rapidly when randomised to automated ventilation (hazard ratio: 1.38 [1.05–1.83]; P=0.03). Conclusions: Fully automated ventilation in haemodynamically stable patients after cardiac surgery optimised lung-protective ventilation during postoperative ventilation, with fewer episodes of severe hypoxaemia and an accelerated resumption of spontaneous breathing. Clinical trial registration: NCT03180203.",

keywords = "automated ventilation, cardiac surgery, intensive care unit, lung protection, mechanical ventilation, postoperative ventilation, protective ventilation, Automation, Humans, Middle Aged, Cardiac Surgical Procedures/instrumentation, Male, Treatment Outcome, Positive-Pressure Respiration, Postoperative Complications/epidemiology, Endpoint Determination, Respiration, Artificial/instrumentation, Female, Aged, Postoperative Care/instrumentation, Respiratory Function Tests",

author = "{De Bie}, {Ashley J.R.} and Neto, {Ary Serpa} and {van Meenen}, {David M.} and Bouwman, {Arthur R.} and Roos, {Arnout N.} and Lameijer, {Joost R.} and Korsten, {Erik H.M.} and Schultz, {Marcus J.} and Bindels, {Alexander J.G.H.}",

year = "2020",

month = nov,

doi = "10.1016/j.bja.2020.06.037",

language = "English",

volume = "125",

pages = "739--749",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Elsevier",

number = "5",

}

TY - JOUR

T1 - Fully automated postoperative ventilation in cardiac surgery patients

T2 - a randomised clinical trial

AU - De Bie, Ashley J.R.

AU - Neto, Ary Serpa

AU - van Meenen, David M.

AU - Bouwman, Arthur R.

AU - Roos, Arnout N.

AU - Lameijer, Joost R.

AU - Korsten, Erik H.M.

AU - Schultz, Marcus J.

AU - Bindels, Alexander J.G.H.

PY - 2020/11

Y1 - 2020/11

N2 - Background: Ensuring that lung-protective ventilation is achieved at scale is challenging in perioperative practice. Fully automated ventilation may be more effective in delivering lung-protective ventilation. Here, we compared automated lung-protective ventilation with conventional ventilation after elective cardiac surgery in haemodynamically stable patients. Methods: In this single-centre investigator-led study, patients were randomly assigned at the end of cardiac surgery to receive either automated (adaptive support ventilation) or conventional ventilation. The primary endpoint was the proportion of postoperative ventilation time characterised by exposure to predefined optimal, acceptable, and critical (injurious) ventilatory parameters in the first three postoperative hours. Secondary outcomes included severe hypoxaemia (SpO2 <85%) and resumption of spontaneous breathing. Data are presented as mean (95% confidence intervals [CIs]). Results: We randomised 220 patients (30.4% females; age: 62–76 yr). Subjects randomised to automated ventilation (n=109) spent a 29.7% (95% CI: 22.1–37.4) higher mean proportion of postoperative ventilation time receiving optimal postoperative ventilation after surgery (P<0.001) compared with subjects receiving conventional postoperative ventilation (n=111). Automated ventilation also reduced the proportion of postoperative ventilation time that subjects were exposed to injurious ventilatory settings by 2.5% (95% CI: 1–4; P=0.003). Severe hypoxaemia was less likely in subjects randomised to automated ventilation (risk ratio: 0.26 [0.22–0.31]; P<0.01). Subjects resumed spontaneous breathing more rapidly when randomised to automated ventilation (hazard ratio: 1.38 [1.05–1.83]; P=0.03). Conclusions: Fully automated ventilation in haemodynamically stable patients after cardiac surgery optimised lung-protective ventilation during postoperative ventilation, with fewer episodes of severe hypoxaemia and an accelerated resumption of spontaneous breathing. Clinical trial registration: NCT03180203.

AB - Background: Ensuring that lung-protective ventilation is achieved at scale is challenging in perioperative practice. Fully automated ventilation may be more effective in delivering lung-protective ventilation. Here, we compared automated lung-protective ventilation with conventional ventilation after elective cardiac surgery in haemodynamically stable patients. Methods: In this single-centre investigator-led study, patients were randomly assigned at the end of cardiac surgery to receive either automated (adaptive support ventilation) or conventional ventilation. The primary endpoint was the proportion of postoperative ventilation time characterised by exposure to predefined optimal, acceptable, and critical (injurious) ventilatory parameters in the first three postoperative hours. Secondary outcomes included severe hypoxaemia (SpO2 <85%) and resumption of spontaneous breathing. Data are presented as mean (95% confidence intervals [CIs]). Results: We randomised 220 patients (30.4% females; age: 62–76 yr). Subjects randomised to automated ventilation (n=109) spent a 29.7% (95% CI: 22.1–37.4) higher mean proportion of postoperative ventilation time receiving optimal postoperative ventilation after surgery (P<0.001) compared with subjects receiving conventional postoperative ventilation (n=111). Automated ventilation also reduced the proportion of postoperative ventilation time that subjects were exposed to injurious ventilatory settings by 2.5% (95% CI: 1–4; P=0.003). Severe hypoxaemia was less likely in subjects randomised to automated ventilation (risk ratio: 0.26 [0.22–0.31]; P<0.01). Subjects resumed spontaneous breathing more rapidly when randomised to automated ventilation (hazard ratio: 1.38 [1.05–1.83]; P=0.03). Conclusions: Fully automated ventilation in haemodynamically stable patients after cardiac surgery optimised lung-protective ventilation during postoperative ventilation, with fewer episodes of severe hypoxaemia and an accelerated resumption of spontaneous breathing. Clinical trial registration: NCT03180203.

KW - automated ventilation

KW - cardiac surgery

KW - intensive care unit

KW - lung protection

KW - mechanical ventilation

KW - postoperative ventilation

KW - protective ventilation

KW - Automation

KW - Humans

KW - Middle Aged

KW - Cardiac Surgical Procedures/instrumentation

KW - Male

KW - Treatment Outcome

KW - Positive-Pressure Respiration

KW - Postoperative Complications/epidemiology

KW - Endpoint Determination

KW - Respiration, Artificial/instrumentation

KW - Female

KW - Aged

KW - Postoperative Care/instrumentation

KW - Respiratory Function Tests

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Fully automated postoperative ventilation in cardiac surgery patients: a randomised clinical trial

Abstract

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Keywords

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Cardiovascular Medicine

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Fully automated postoperative ventilation in cardiac surgery patients: a randomised clinical trial

Abstract

Funding

Keywords

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Cardiovascular Medicine

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