Brain protective ventilation in acute brain injury patients with use of fully automated ventilation (BRAVE): A cross-over clinical trial.

IF 6.8 2区 医学 Q1 ANESTHESIOLOGY
Robin L Goossen, Sibilla Gavinelli, Simone Dragoni, David M P van Meenen, Frederique Paulus, Marcus J S Schultz, Lorenzo Ball, Nicolo' Antonino Patroniti, Chiara Robba
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引用次数: 0

Abstract

Background: Invasive ventilation can be challenging in acute brain injury (ABI) patients as partial pressure of carbon dioxide and oxygen need to be kept in precise optimal ranges while simultaneously applying lung-protective ventilation. Fully automated ventilation may be effective in achieving protective ventilation targets for brain and lung.

Objectives: To compare automated ventilation to conventional ventilation for ABI patients.

Design: Single-centre, observational, cross-over trial.

Setting: Primary care hospital in Italy, recruiting in 2024.

Patients: Twenty ABI patients receiving invasive mechanical ventilation.

Methods: We performed 3 h of data collection during conventional ventilation followed by 3 h of data collection during automated ventilation.

Main outcome measure: The primary endpoint was the percentage of breaths in three predefined zones of ventilatory targets, defined as optimal, acceptable and critical. The zones were based on patient-specific ranges of four measures: end-tidal carbon dioxide (EtCO2), peripheral oxygen saturation (SpO2), tidal volume (VT), and maximum airway pressures (Pmax).

Results: A total of 20 patients were included. With automated ventilation the proportion [range] of breaths within the optimal zone significantly increased from 2.7% [0.0 to 23.4] to 30.5% [0.9 to 66.3] (P < 0.001). Automated ventilation markedly decreased the proportion of breaths in the critical zone, from 16.6% [1.9 to 41.3] to 2.1% [0.5 to 7.4] (P < 0.001), while slightly reducing breaths in the acceptable zone from 58.1% [34.4 to 90.9] to 45.1% [25.4 to 90.8] (P < 0.001). Optimal breaths increased for EtCO2, SpO2, and VT, but declined for Pmax with automation. The percentage of time spent in each ventilation zone mirrored the percentage of breaths in each zone.

Conclusion: Automated ventilation outperformed conventional ventilation in maintaining protective ventilation targets for brain and lung in ABI patients.

Trial registration: Clinicaltrials.gov identifier: NCT06367816.

全自动通气在急性脑损伤患者脑保护通气中的应用:一项交叉临床试验。
背景:有创通气在急性脑损伤(ABI)患者中具有挑战性,因为二氧化碳和氧气分压需要保持在精确的最佳范围内,同时应用肺保护性通气。全自动通气可有效达到脑和肺的保护性通气目标。目的:比较ABI患者的自动通气与常规通气。设计:单中心、观察性、交叉试验。环境:意大利初级保健医院,2024年招聘。患者:20例ABI患者接受有创机械通气。方法:我们在常规通气期间进行了3小时的数据收集,然后在自动通气期间进行了3小时的数据收集。主要结局指标:主要终点是三个预定义的呼吸目标区域的呼吸百分比,定义为最佳,可接受和关键。该区域基于患者特定的四项测量范围:潮末二氧化碳(EtCO2)、外周氧饱和度(SpO2)、潮气量(VT)和最大气道压力(Pmax)。结果:共纳入20例患者。应用自动通气后,最佳呼吸区呼吸比例[范围]由2.7%[0.0 ~ 23.4]显著增加至30.5% [0.9 ~ 66.3](P)。结论:自动通气在维持ABI患者脑、肺的保护性通气指标方面优于常规通气。试验注册:Clinicaltrials.gov标识符:NCT06367816。
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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