Jolliet, P.

Laubscher, T.

Matskovskiy, I.

Novotni, D.

Oddo, M.

Oshorov, A.

Piquilloud, L.

Polupan, A.

Revelly, J.P.

PubMed

L Piquilloud

A Polupan

I Matskovskiy

A Oshorov

D Novotni

T Laubscher

M Oddo

P Jolliet

JP Revelly

Springer - Publisher Connector

IN NEURO CRITICAL CARE, CAPNIA CAN BE OPTIMALLY CONTROLLED USING A CLOSED-LOOP VENTILATION SYSTEM BASED ON END-TIDAL CO2 SIGNAL (INTELLIVENT-ASV®): PRELIMINARY RESULTS OF A PROSPECTIVE INTERVENTIONAL STUDY

Piquilloud, L

Polupan, A

Matskovskiy, I

Oshorov, A

Novotni, D

Laubscher, T

Oddo, M

Revelly, J-P

Serveur académique lausannois

In neuro critical care, capnia can be optimally controlled using a closedloop ventilation system based on end-tidal CO2 signal (intellivent-asv): preliminary results of a prospective interventional study.

Crossref

Intensive Care Medicine Experimental

In neuro critical care, capnia can be optimally controlled using a closed-loop ventilation system based on end-tidal CO2 signal (intellivent-asv®): preliminary results of a prospective interventional study

POSTER PRESENTATION Open Access
In neuro critical care, capnia can be optimally
controlled using a closed-loop ventilation system
based on end-tidal CO2 signal (intellivent-asv®):
preliminary results of a prospective interventional
study
L Piquilloud1*, A Polupan2, I Matskovskiy2, A Oshorov2, D Novotni3, T Laubscher3, M Oddo1, P Jolliet1, JP Revelly1
From ESICM LIVES 2015
Berlin, Germany. 3-7 October 2015
Introduction
Both hypo- and hypercapnia can be deleterious to brain
injured patients. Due to the variability of CO2 produc-
tion and elimination and to the unpredictable effects of
ventilator settings changes, strict arterial CO2 partial
pressure (PaCO2) control is difficult to obtain. Concei-
vably, using expired (end-tidal) CO2 as the input signal
of closed-loop ventilation (Intellivent-ASV®) should
optimize CO2 control compared to manual ventilator
setting changes based on PaCO2 measurements.
Objectives
The aim of this study was to compare PaCO2 evolution
over time during standard controlled ventilation and
during Intellivent-ASV®.
Methods
Prospective interventional randomized study with a
crossover design. Comparison of PaCO2 evolution during
two sequential 2-hour periods of ventilation (standard
ventilation and Intellivent-ASV® version VUP02.11c in
the “brain injury setting”), applied in random-order. A
one-hour washout period was inserted between both per-
iods. Arterial blood gas analysis was performed every
30 minutes. The number of manual settings adjustments
made on the ventilator and actions performed to reduce
intracranial pressure (ICP) were also recorded. Due to
the small number of patients in this preliminary dataset,
no statistical differences were tested.
Results
(medians [IQR]):11 patients were included (6 severe
traumatic brain injury, 4 subarachnoid hemorrhage and
1 intra-cerebral hematoma). Age: 52 [42-54] years. Body
mass index: 25.5 [24.7-27.0] kg/m2, GCS at admission:
6 [4-6.5]. SAPS 2 score: 42 [32-50]. PaCO2 was 36 [33-
37] mmHg (range: 28 and 43 mmHg) during standard
ventilation and 36 [34-37] (range: 30 and 43 mmHg)
during Intellivent-ASV®. DeltaPaCO2 between two con-
secutive PaCO2 measurements are illustrated in Figure 1.
During standard ventilation, 22 settings adaptations
were performed whereas only two manual adjustments
were made during Intellivent-ASV®. Four (2 increase in
sedation and 2 hypertonic saline administration) and 2
(increase in sedation) actions were performed in order
to decrease ICP during standard ventilation and Intelli-
vent-ASV® respectively.
Conclusions
The Intellivent-ASV® CO2-regulated closed-loop ventila-
tion mode can be safely used to deliver automated ventila-
tion in brain injured patients. PaCO2 never reached
extreme values and delta PaCO2 were very low during
Intellivent-ASV®. Accordingly, fewer ventilator settings
adaptations were required during Intellivent-ASV®. These
preliminary results are promising and more patients must
be included to evaluate the potential advantage of using
1University Hospital of Lausanne, Adult Intensive Care and Burn Unit,
Lausanne, Switzerland
Full list of author information is available at the end of the article
Piquilloud et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A662
http://www.icm-experimental.com/content/3/S1/A662
© 2015 Piquilloud et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
Intellivent-ASV® to optimize the control of capnia during
neuro-resuscitation.
Authors’ details
1University Hospital of Lausanne, Adult Intensive Care and Burn Unit,
Lausanne, Switzerland. 2Burdenko Neurosurgical Institute of Moscow,
Intensive Care Department, Moscow, Russian Federation. 3Hamilton Medical
Research, Bonaduz, Switzerland.
Published: 1 October 2015
doi:10.1186/2197-425X-3-S1-A662
Cite this article as: Piquilloud et al.: In neuro critical care, capnia can be
optimally controlled using a closed-loop ventilation system based on
end-tidal CO2 signal (intellivent-asv®): preliminary results of a
prospective interventional study. Intensive Care Medicine Experimental
2015 3(Suppl 1):A662.
Submit your manuscript to a 
journal and benefi t from:
7 Convenient online submission
7 Rigorous peer review
7 Immediate publication on acceptance
7 Open access: articles freely available online
7 High visibility within the fi eld
7 Retaining the copyright to your article
    Submit your next manuscript at 7 springeropen.com
Figure 1
Piquilloud et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A662
http://www.icm-experimental.com/content/3/S1/A662
Page 2 of 2


POSTER PRESENTATION Open AccessIn neuro critical care, capnia can be optimallycontrolled using a closed-loop ventilation systembased on end-tidal CO2 signal (intellivent-asv®):preliminary results of a prospective interventionalstudyL Piquilloud1*, A Polupan2, I Matskovskiy2, A Oshorov2, D Novotni3, T Laubscher3, M Oddo1, P Jolliet1, JP Revelly1From ESICM LIVES 2015Berlin, Germany. 3-7 October 2015IntroductionBoth hypo- and hypercapnia can be deleterious to braininjured patients. Due to the variability of CO2 produc-tion and elimination and to the unpredictable effects ofventilator settings changes, strict arterial CO2 partialpressure (PaCO2) control is difficult to obtain. Concei-vably, using expired (end-tidal) CO2 as the input signalof closed-loop ventilation (Intellivent-ASV®) shouldoptimize CO2 control compared to manual ventilatorsetting changes based on PaCO2 measurements.ObjectivesThe aim of this study was to compare PaCO2 evolutionover time during standard controlled ventilation andduring Intellivent-ASV®.MethodsProspective interventional randomized study with acrossover design. Comparison of PaCO2 evolution duringtwo sequential 2-hour periods of ventilation (standardventilation and Intellivent-ASV® version VUP02.11c inthe “brain injury setting”), applied in random-order. Aone-hour washout period was inserted between both per-iods. Arterial blood gas analysis was performed every30 minutes. The number of manual settings adjustmentsmade on the ventilator and actions performed to reduceintracranial pressure (ICP) were also recorded. Due tothe small number of patients in this preliminary dataset,no statistical differences were tested.Results(medians [IQR]):11 patients were included (6 severetraumatic brain injury, 4 subarachnoid hemorrhage and1 intra-cerebral hematoma). Age: 52 [42-54] years. Bodymass index: 25.5 [24.7-27.0] kg/m2, GCS at admission:6 [4-6.5]. SAPS 2 score: 42 [32-50]. PaCO2 was 36 [33-37] mmHg (range: 28 and 43 mmHg) during standardventilation and 36 [34-37] (range: 30 and 43 mmHg)during Intellivent-ASV®. DeltaPaCO2 between two con-secutive PaCO2 measurements are illustrated in Figure 1.During standard ventilation, 22 settings adaptationswere performed whereas only two manual adjustmentswere made during Intellivent-ASV®. Four (2 increase insedation and 2 hypertonic saline administration) and 2(increase in sedation) actions were performed in orderto decrease ICP during standard ventilation and Intelli-vent-ASV® respectively.ConclusionsThe Intellivent-ASV® CO2-regulated closed-loop ventila-tion mode can be safely used to deliver automated ventila-tion in brain injured patients. PaCO2 never reachedextreme values and delta PaCO2 were very low duringIntellivent-ASV®. Accordingly, fewer ventilator settingsadaptations were required during Intellivent-ASV®. Thesepreliminary results are promising and more patients mustbe included to evaluate the potential advantage of using1University Hospital of Lausanne, Adult Intensive Care and Burn Unit,Lausanne, SwitzerlandFull list of author information is available at the end of the articlePiquilloud et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A662http://www.icm-experimental.com/content/3/S1/A662© 2015 Piquilloud et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, providedthe original work is properly cited.Intellivent-ASV® to optimize the control of capnia duringneuro-resuscitation.Authors’ details1University Hospital of Lausanne, Adult Intensive Care and Burn Unit,Lausanne, Switzerland. 2Burdenko Neurosurgical Institute of Moscow,Intensive Care Department, Moscow, Russian Federation. 3Hamilton MedicalResearch, Bonaduz, Switzerland.Published: 1 October 2015doi:10.1186/2197-425X-3-S1-A662Cite this article as: Piquilloud et al.: In neuro critical care, capnia can beoptimally controlled using a closed-loop ventilation system based onend-tidal CO2 signal (intellivent-asv®): preliminary results of aprospective interventional study. Intensive Care Medicine Experimental2015 3(Suppl 1):A662.Submit your manuscript to a journal and benefi t from:7 Convenient online submission7 Rigorous peer review7 Immediate publication on acceptance7 Open access: articles freely available online7 High visibility within the fi eld7 Retaining the copyright to your article    Submit your next manuscript at 7 springeropen.comFigure 1Piquilloud et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A662http://www.icm-experimental.com/content/3/S1/A662Page 2 of 2

In neuro critical care, capnia can be optimally controlled using a closed-loop ventilation system based on end-tidal CO2 signal (intellivent-asv(®)): preliminary results of a prospective interventional study.

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In neuro critical care, capnia can be optimally controlled using a closed-loop ventilation system based on end-tidal CO2 signal (intellivent-asv(®)): preliminary results of a prospective interventional study.

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