Intensive Care Medicine

, Volume 38, Issue 5, pp 781–787 | Cite as

Safety and efficacy of a fully closed-loop control ventilation (IntelliVent-ASV®) in sedated ICU patients with acute respiratory failure: a prospective randomized crossover study

  • Jean-Michel Arnal
  • Marc Wysocki
  • Dominik Novotni
  • Didier Demory
  • Ricardo Lopez
  • Stéphane Donati
  • Isabelle Granier
  • Gaëlle Corno
  • Jacques Durand-Gasselin



IntelliVent-ASV® is a development of adaptive support ventilation (ASV) that automatically adjusts ventilation and oxygenation parameters. This study assessed the safety and efficacy of IntelliVent-ASV® in sedated intensive care unit (ICU) patients with acute respiratory failure.


This prospective randomized crossover comparative study was conducted in a 12-bed ICU in a general hospital. Two periods of 2 h of ventilation in randomly applied ASV or IntelliVent-ASV® were compared in 50 sedated, passively ventilated patients. Tidal volume (V T), respiratory rate (RR), inspiratory pressure (P INSP), SpO2 and ETCO2 were continuously monitored and recorded breath by breath. Mean values over the 2-h period were calculated. Respiratory mechanics, plateau pressure (P PLAT) and blood gas exchanges were measured at the end of each period.


There was no safety issue requiring premature interruption of IntelliVent-ASV®. Minute ventilation (MV) and V T decreased from 7.6 (6.5–9.5) to 6.8 (6.0–8.0) L/min (p < 0.001) and from 8.3 (7.8–9.0) to 8.1 (7.7–8.6) mL/kg PBW (p = 0.003) during IntelliVent-ASV® as compared to ASV. P PLAT and FiO2 decreased from 24 (20–29) to 20 (19–25) cmH2O (p = 0.005) and from 40 (30–50) to 30 (30–39) % (p < 0.001) during IntelliVent-ASV® as compared to ASV. RR, P INSP, and PEEP decreased as well during IntelliVent-ASV® as compared to ASV. Respiratory mechanics, pH, PaO2 and PaO2/FiO2 ratio were not different but PaCO2 was slightly higher during IntelliVent-ASV® as compared to ASV.


In passive patients with acute respiratory failure, IntelliVent-ASV® was safe and able to ventilate patients with less pressure, volume and FiO2 while producing the same results in terms of oxygenation.


Mechanical ventilation Closed-loop ventilation ARDS Acute respiratory failure 



This study was sponsored by Hamilton Medical. J.-M. Arnal was supported by Hamilton Medical in presenting the results at international conferences.


  1. 1.
    Chatburn R, Mireles-Cabodevila E (2011) Closed-loop control of mechanical ventilation: description and classification of targeting schemes. Respir Care 56:85–98PubMedCrossRefGoogle Scholar
  2. 2.
    Wysocki M, Brunner JX (2007) Closed-loop ventilation: an emerging standard of care? Crit Care Clin 23:223–240PubMedCrossRefGoogle Scholar
  3. 3.
    Arnal JM, Wysocki M, Nafati C, Donati SY, Granier I, Corno G, Durand-Gasselin J (2008) Automatic selection of breathing pattern using adaptive support ventilation. Intensive Care Med 34:75–81PubMedCrossRefGoogle Scholar
  4. 4.
    Sulemanji D, Marchese A, Garberini P, Wysocki M, Kacmarek R (2009) Adaptive support ventilation: an appropriate mechanical ventilation strategy for acute respiratory distress syndrome? Anesthesiology 111:863–870PubMedCrossRefGoogle Scholar
  5. 5.
    Gruber PC, Gomersall CD, Leung P, Joynt GM, Ng SK, Ho KM, Underwood MJ (2008) Randomized controlled trial comparing adaptive-support ventilation with pressure-regulated volume-controlled ventilation with automode in weaning patients after cardiac surgery. Anesthesiology 109:81–87PubMedCrossRefGoogle Scholar
  6. 6.
    Kirakli C, Ozdemir I, Zeren Ucar Z, Cimen P, Kepil S, Ozkran SA (2011) Adaptive support ventilation for faster weaning in COPD: a randomized controlled trial. Eur Respir J 38:774–780PubMedCrossRefGoogle Scholar
  7. 7.
    Chen CW, Wu CP, Dai YL, Perng WC, Chian CF, Su WL, Huang YC (2011) Effect of implementing adaptive support ventilation in a medical intensive care unit. Respir Care 56:976–983PubMedCrossRefGoogle Scholar
  8. 8.
    Tassaux D, Dalmas E, Gratadour P, Jolliet P (2002) Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support. Crit Care Med 30:801–807PubMedCrossRefGoogle Scholar
  9. 9.
    Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308CrossRefGoogle Scholar
  10. 10.
    Acute Respiratory Distress Syndrome Network (2004) Higher versus lower positive end-expiratory pressures in patients with acute respiratory distress syndrome. N Engl J Med 351:327–336CrossRefGoogle Scholar
  11. 11.
    Iotti GA, Braschi A, Brunner JX, Smits T, Olivei M, Palo A, Veronesi R (1995) Respiratory mechanics by least squares fitting in mechanically ventilated patients: applications during paralysis and during pressure support ventilation. Intensive Care Med 21:406–413PubMedCrossRefGoogle Scholar
  12. 12.
    Brunner JX, Laubsher TP, Banner MJ, Iotti G, Brashi A (1995) Simple method to measure total expiratory time constant based on passive expiratory flow-volume curve. Crit Care Med 23:1117–1122PubMedCrossRefGoogle Scholar
  13. 13.
    Lourens MS, Van Den Berg B, Aerts JG, Verbraak AFM, Hoogsteden HC, Bogaard JM (2000) Expiratory time constants in mechanically ventilated patients with and without COPD. Intensive Care Med 26:1612–1618PubMedCrossRefGoogle Scholar
  14. 14.
    Lucangelo U, Blanch L (2004) Dead space. Intensive Care Med 30:576–579PubMedCrossRefGoogle Scholar
  15. 15.
    Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Le Gall JR, Morris A, Spragg R (1994) Report of the American-European Consensus Conference on acute respiratory distress syndrome: definitions, mechanism, relevant outcomes, and clinical trial coordination. Consensus Committee. Am J Respir Crit Care Med 149:818–824PubMedGoogle Scholar
  16. 16.
    Iotti G, Polito A, Belliato M, Pasero D, Beduneau G, Wysocki M, Brunner J, Brashi A, Brochard L, Mancebo J, Richard JC, Slutsky A (2010) Adaptive support ventilation versus conventional ventilation for total ventilatory support in acute respiratory failure. Intensive Care Med 36:1371–1379PubMedCrossRefGoogle Scholar
  17. 17.
    Ware L, Matthay M (2000) The acute respiratory distress syndrome. N Engl J Med 342:1334–1349PubMedCrossRefGoogle Scholar
  18. 18.
    De Graaff AE, Dongelmans DA, Binnekade JM, De Jonge E (2011) Clinician’s response to hyperoxia in ventilated patients in a Dutch ICU depends on the level of FiO2. Intensive Care Med 37:46–51PubMedCrossRefGoogle Scholar
  19. 19.
    Dojat M, Harf A, Touchard D, Lemaire F, Brochard L (2000) Clinical evaluation of a computer-controlled pressure support mode. Am J Respir Crit Care Med 161:1161–1166PubMedGoogle Scholar
  20. 20.
    Lellouche F, Bouchard PA, Laubsher T, Blackburn S, L’Her E, Wysocki M (2010) Prospective randomized controlled study comparing conventional ventilation versus a fully close loop ventilation (IntelliVent®) in post cardiac surgery ICU patients. Intensive Care Med 36:S752Google Scholar
  21. 21.
    Constantin JM, Leone M, Jaber S, Allaouchiche B, Orban JC, Cannesson M, Fourcade O, Morel J, Martin C, Lefrant JY, AzuRéa (2010) Activity and the available human resources working in 66 French Southern intensive care units. Ann Fr Anesth Reanim 29:512–517Google Scholar
  22. 22.
    Tarnow-Mordi WO, Hau C, Warden A, Shearer AJ (2000) Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit. Lancet 356:185–189PubMedCrossRefGoogle Scholar
  23. 23.
    Embriaco N, Papazian L, Kentish-Barnes N, Pochard F, Azoulay E (2007) Burnout syndrome among critical care healthcare workers. Curr Opin Crit Care 13:482–488PubMedCrossRefGoogle Scholar
  24. 24.
    Parkes J, Hyde C, Deeks J, Milne R (2001) Teaching critical appraisal skills in health care settings. Cochrane Database Syst Rev CD001270Google Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Jean-Michel Arnal
    • 1
  • Marc Wysocki
    • 2
  • Dominik Novotni
    • 2
  • Didier Demory
    • 1
  • Ricardo Lopez
    • 2
  • Stéphane Donati
    • 1
  • Isabelle Granier
    • 1
  • Gaëlle Corno
    • 1
  • Jacques Durand-Gasselin
    • 1
  1. 1.Service de Réanimation PolyvalenteHôpital Font PréToulonFrance
  2. 2.Department of Medical ResearchHamilton MedicalBonaduzSwitzerland

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