Decision support system to evaluate VENTilation in the Acute Respiratory Distress Syndrome

RationaleThe acute respiratory distress syndrome (ARDS) shows significant heterogeneity in responsiveness to changes in mechanical ventilation and lacks personalisation. ObjectivesInvestigate the clinical efficacy of a physiologic-based ventilatory decision support system (DSS) on ARDS patients. MethodsAn international, multi-centre, randomized, open-label study enrolling patients with ARDS during the COVID-19 pandemic. The primary outcome was to detect a reduction in average driving pressure between groups. Secondary outcomes included several clinically relevant measures of respiratory physiology, ventilator free days; time from control mode to support mode; number of changes in ventilator settings per day; percentage of time in control and support mode ventilation; ventilation related and device related adverse events; and number of times the advice is followed. Measurements and Main Results. 95 patients were randomized to this study. The DSS showed was no effect in the average driving pressure between arms. Patients in the intervention arm had statistically improved oxygenation index when in support mode ventilation (-1.41, 95% CI: -2.76, -0.08; p=0.0370). Ventilatory ratio was also significantly improved in the intervention arm for patients in control mode ventilation (-0.63, 95% CI: -1.08, -0.17, p= 0.0068). The application of the DSS resulted in a significantly increased number of ventilator changes for pressure settings and respiratory frequency. ConclusionsThe application of a physiological model-based decision support system for advice on mechanical ventilation in patients with COVID-19 and non-COVID-19 ARDS showed that application of about 60% of advice improved physiological state, despite no significant difference in driving pressure as a primary outcome measure.