Automated Control of Mechanical Ventilation During General Anaesthesia

University Hospital Schleswig-Holstein100 enrolled

Overview

Prospective, bicentric observational study to assess a novel system for automated control of mechanical ventilation (Smart Vent Control, SVC) during general anesthesia.

The "Automated control of mechanical ventilation during general anesthesia study (AVAS study) is an international investigator-initiated bicentric observational study investigating the application of Smart Vent Control (SVC) during general anesthesia. The main objective of this study is to describe the application of SVC and to assess its safety and efficacy.

Study Type

OBSERVATIONAL

Enrollment

100

Conditions

Anesthesia

Interventions

Smart Vent ControlDEVICE

Smart Vent Control (SVC) was designed to automatically control the following ventilator settings: mechanical breathing frequency, inspiratory pressure, pressure support, inspiratory time, trigger sensitivity. SVC adjusts the ventilator settings with the aim to keep a patient stable in a target zone (TZ). Numerous predefined TZs exist that can be set according to the current therapeutic situation. All TZs are adoptable by the user for each individual patient and consist of upper and lower limits for tidal volume and for the partial pressure of end-tidal carbon dioxide (PetCO2). Based on these limits, the system classifies the current quality of ventilation, called Classification of Ventilation, and derives new ventilator settings accordingly. SVC is available as a software option on Zeus Infinity Empowered anesthesia machines (Drägerwerk AG \& Co. KGAa, Lübeck, Germany) and is approved as a medical product according to 93/42/European Economic Community.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Planned elective surgery of the upper limb, lower limb or peripheral vascular surgery in general anesthesia * Patient is classified as American Society of Anesthesiologists physical status (ASA) I, II or III * Age ≥ 18 years * Written consent of the patient for study participation Exclusion Criteria: * Mild, moderate or severe acute respiratory distress syndrome (ARDS)\[10\] * Known chronic obstructive pulmonary disease Gold stage III or higher * Two or more of the following organ failures * Mild, moderate or severe ARDS * Hemodynamic instability: systolic blood pressure \< 90 mm Hg, mean arterial pressure \< 70 mm Hg or administration of any vasoactive drugs. * Acute renal failure: oliguria (urine output \< 0.5 ml/kg/h for at least 2 hours despite of adequate management or creatinine increase \> 0.5 mg/dl * Cerebral failure: loose of consciousness or encephalopathy * Patient is pregnant.

Locations (2)

University Hospital St. Pölten, Department of Anesthesiology and Intensive Care Medicine

Sankt Pölten, Austria

University Medical Center Schleswig-Holstein, Campus Kiel, Department of Anesthesiology and Intensive Care Medicine

Kiel, Germany

Outcomes

Primary Outcomes

Frequency of adverse events.

* Severe hypoventilation defined as minute volume lower than 40 ml/kg predicted body weight for longer than 5 minutes * Apnea for longer than 90 seconds * Hyperventilation defined as PetCO2 lower than 5 mm Hg of the lower target setting for SVC for longer than 5 minutes * Hypoventilation defined as PetCO2 higher than 5 mm Hg of the upper target setting for the SVC for longer than 5 minutes * Respiratory rate \> 35 breaths per minute for longer than 5 minutes * Any override or stop of the automated controlled ventilation settings by the anesthesiologist in charge if the settings are clinically not acceptable. Reasons for overriding or stopping the system will be noted.

Time frame: During artificial ventilation with SVC (up to 8 hours).

Secondary Outcomes

Frequency of normoventilated, hypoventilated and hyperventilated patients.

The responsible anesthesiologist defines a target range for the arterial partial pressure of carbon dioxide (PaCO2\_target) before the induction of the general anesthesia and sets up the corresponding endtidal CO2-range in the automated ventilation system. 15 minutes after the begin of the surgical procedure an arterial blood gas analysis will be performed and the PaCO2 will be measured. Then patients will be classified as follows: * hypoventilated patient: PaCO2 \> (PaCO2\_target+5) * hyperventilated patient: PaCO2 \< (PaCO2\_target-5) * normoventilated patient: (PaCO2\_target-5) ≤ PaCO2 ≤ PaCO2\_target+5

Time frame: During artificial ventilation with SVC (up to 8 hours).

Time period between switch from controlled ventilation to augmented ventilation and achievement of stable assisted ventilation of the patient.

Time frame: During artificial ventilation with SVC (up to 8 hours).

Proportion of time within the target zones for tidal volume and PetCO2 as individually set up for each patient by the user.

Time frame: During artificial ventilation with SVC (up to 8 hours).

Data from ClinicalTrials.gov

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