Effects of closed loop ventilation on ventilator settings, patient outcomes and ICU staff workloads - a systematic review.

IF 4.2 2区 医学 Q1 ANESTHESIOLOGY
European Journal of Anaesthesiology Pub Date : 2024-06-01 Epub Date: 2024-03-04 DOI:10.1097/EJA.0000000000001972
Robin L Goossen, Marcus J Schultz, Edda Tschernko, Michelle S Chew, Chiara Robba, Frederique Paulus, Pim L J van der Heiden, Laura A Buiteman-Kruizinga
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引用次数: 0

Abstract

Background: Lung protective ventilation is considered standard of care in the intensive care unit. However, modifying the ventilator settings can be challenging and is time consuming. Closed loop modes of ventilation are increasingly attractive for use in critically ill patients. With closed loop ventilation, settings that are typically managed by the ICU professionals are under control of the ventilator's algorithms.

Objectives: To describe the effectiveness, safety, efficacy and workload with currently available closed loop ventilation modes.

Design: Systematic review of randomised clinical trials.

Data sources: A comprehensive systematic search in PubMed, Embase and the Cochrane Central register of Controlled Trials search was performed in January 2023.

Eligibility criteria: Randomised clinical trials that compared closed loop ventilation with conventional ventilation modes and reported on effectiveness, safety, efficacy or workload.

Results: The search identified 51 studies that met the inclusion criteria. Closed loop ventilation, when compared with conventional ventilation, demonstrates enhanced management of crucial ventilator variables and parameters essential for lung protection across diverse patient cohorts. Adverse events were seldom reported. Several studies indicate potential improvements in patient outcomes with closed loop ventilation; however, it is worth noting that these studies might have been underpowered to conclusively demonstrate such benefits. Closed loop ventilation resulted in a reduction of various aspects associated with the workload of ICU professionals but there have been no studies that studied workload in sufficient detail.

Conclusions: Closed loop ventilation modes are at least as effective in choosing correct ventilator settings as ventilation performed by ICU professionals and have the potential to reduce the workload related to ventilation. Nevertheless, there is a lack of sufficient research to comprehensively assess the overall impact of these modes on patient outcomes, and on the workload of ICU staff.

闭环通气对呼吸机设置、患者预后和重症监护室工作人员工作量的影响 - 系统综述。
背景:肺保护性通气被认为是重症监护病房的标准护理。然而,改变呼吸机的设置既具有挑战性,又耗费时间。闭环通气模式对重症患者的吸引力与日俱增。通过闭环通气,通常由重症监护室专业人员管理的设置将由呼吸机算法控制:描述目前可用的闭环通气模式的有效性、安全性、疗效和工作量:设计:对随机临床试验进行系统回顾:数据来源:2023 年 1 月在 PubMed、Embase 和 Cochrane 对照试验中央登记册中进行了全面的系统检索:将闭环通气与传统通气模式进行比较,并报告有效性、安全性、疗效或工作量的随机临床试验:结果:检索发现 51 项研究符合纳入标准。闭环通气与传统通气相比,在不同的患者群组中,对肺保护所必需的关键通气变量和参数的管理得到了加强。很少有不良事件的报道。有几项研究表明,闭环通气可改善患者的预后;但值得注意的是,这些研究可能并没有充分证明闭环通气的益处。闭环通气减少了 ICU 专业人员各方面的工作量,但目前还没有对工作量进行足够详细研究的研究:闭环通气模式在选择正确的呼吸机设置方面至少与 ICU 专业人员进行的通气一样有效,并有可能减少与通气相关的工作量。然而,目前还缺乏足够的研究来全面评估这些模式对患者预后和 ICU 工作人员工作量的总体影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.90
自引率
11.10%
发文量
351
审稿时长
6-12 weeks
期刊介绍: The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).
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