Closed-loop Versus Conventional Ventilation Mode During Mobilization Period in Critical Care Patients

Prospective randomized cross over study including all consecutive ventilated patient with predicted duration of ventilation > 48 hours, inspired oxygen fraction < 60% and without neuromuscular blocking agent.

Patient were randomized to be ventilated with full closed-loop control or conventional ventilation 30 minutes before the first nursing period after inclusion. The ventilator was switched in the other mode (conventional or full closed-loop respectively), 30 minutes before the following nursing period. Between this two consecutive nursing periods, ventilation mode is choosed by the attending physician.

The primary outcome was the oxygenation measured by pulse oxymetry during the nursing periods.

• Nursing 1 : INTELLIVENT-ASV (Other)
• Nursing 2 : INTELLIVENT-ASV (Other)
• Nursing 1 : Conventional mode (Other)
• Nursing 2 : Conventional mode (Other)

Primary outcomes

• Time spent with SpO2 values > 90 and < 95% [1 day]: Pulse oxymetry monitoring

Secondary outcomes

• Time spent with SpO2 values < or = 90% [1 day]: Pulse oxymetry monitoring
• Time spent with SpO2 values > or = 95% [1 day]: Pulse oxymetry monitoring

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Invasive mechanical ventilation for expected time >48h

Exclusion Criteria:

* Pregnancy
* Neuromuscular blocking agent (discontinuous or continuous) infusion
* Inspired oxygen fraction (FiO2) setting > or = 60%
* Mobilization contraindication (hemodynamic instability, unstable vertebral trauma, etc.)
* Neurological breathing (patients with brain injury)
* Pulse oxymetry monitoring unavailable
* Expected ventilation weaning <24h after randomization.
* Moribund patients

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• Results publication: Chelly J, Mazerand S, Jochmans S, Weyer CM, Pourcine F, Ellrodt O, Thieulot-Rolin N, Serbource-Goguel J, Sy O, Vong LVP, Monchi M. Automated vs. conventional ventilation in the ICU: a randomized controlled crossover trial comparing blood oxygen saturation during daily nursing procedures (I-NURSING). Crit Care. 2020 Jul 22;24(1):453. doi: 10.1186/s13054-020-03155-3. PMID 32698860

• Jonathan Chelly, MD, Principal investigator, Mixed, ICU, Centre Hospitalier de Melun