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Evidence-Based Considerations for the Design of an Open-Source Ventilator: A Systematic Review

OBJECTIVE: To inform the design of open-source ventilators, we performed a systematic review of clinical practice guidelines (CPGs) to consolidate the evidence on mechanical ventilation strategies that result in improved patient-important outcomes for acute hypoxic respiratory failure. DATA SOURCES:...

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Autores principales: Dave, Chintan, Sivajohan, Asaanth, Basmaji, John, Slessarev, Marat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9249267/
https://www.ncbi.nlm.nih.gov/pubmed/35795401
http://dx.doi.org/10.1097/CCE.0000000000000723
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author Dave, Chintan
Sivajohan, Asaanth
Basmaji, John
Slessarev, Marat
author_facet Dave, Chintan
Sivajohan, Asaanth
Basmaji, John
Slessarev, Marat
author_sort Dave, Chintan
collection PubMed
description OBJECTIVE: To inform the design of open-source ventilators, we performed a systematic review of clinical practice guidelines (CPGs) to consolidate the evidence on mechanical ventilation strategies that result in improved patient-important outcomes for acute hypoxic respiratory failure. DATA SOURCES: We developed a search strategy to identify relevant CPGs from Ovid Medline, Ovid Medline In-Process & Other Non-Indexed Citations, Embase, the Cochrane Library, Mendeley, and Google scholar from 2010 to February 17, 2022. STUDY SELECTION: Using a two-step screening process with two independent reviewers, we included CPGs that made recommendations on mechanical ventilation strategies of interest. Guidelines that reported at least one recommendation about mechanical ventilation in ICU patients with acute hypoxic respiratory failure were included. DATA EXTRACTION: From the 13 eligible guidelines, we collected data on country, aim, patient population, impact on morbidity and mortality (effect size and CIs), recommendations, strength of Recommendation (as per Grading of Recommendations, Assessment, Development and Evaluations), and details of supporting evidence base. DATA SYNTHESIS: We identified three ventilation strategies that confer a mortality and morbidity benefit for ventilated patients with acute hypoxic respiratory failure: low-tidal volume ventilation, plateau pressures of less than 30 cm H(2)O, and higher positive end-expiratory pressure (PEEP). These moderate-to-strong recommendations were based on moderate-to-high certainty in evidence. We identified several other recommendations with no or minimal certainty in evidence. CONCLUSIONS: Our systematic review of international CPGs identified no recommendations favoring specific mode of ventilation and three ventilation strategies that confer mortality and morbidity benefits, backed by moderate-to-strong evidence. Ventilator design teams must include the ability to consistently provide and measure low-tidal volume ventilation, plateau pressures of less than 30 cm H(2)O, and higher PEEP into their designs. Based on our findings, we provide the first public framework for open-source ventilator design.
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spelling pubmed-92492672022-07-05 Evidence-Based Considerations for the Design of an Open-Source Ventilator: A Systematic Review Dave, Chintan Sivajohan, Asaanth Basmaji, John Slessarev, Marat Crit Care Explor Systematic Review OBJECTIVE: To inform the design of open-source ventilators, we performed a systematic review of clinical practice guidelines (CPGs) to consolidate the evidence on mechanical ventilation strategies that result in improved patient-important outcomes for acute hypoxic respiratory failure. DATA SOURCES: We developed a search strategy to identify relevant CPGs from Ovid Medline, Ovid Medline In-Process & Other Non-Indexed Citations, Embase, the Cochrane Library, Mendeley, and Google scholar from 2010 to February 17, 2022. STUDY SELECTION: Using a two-step screening process with two independent reviewers, we included CPGs that made recommendations on mechanical ventilation strategies of interest. Guidelines that reported at least one recommendation about mechanical ventilation in ICU patients with acute hypoxic respiratory failure were included. DATA EXTRACTION: From the 13 eligible guidelines, we collected data on country, aim, patient population, impact on morbidity and mortality (effect size and CIs), recommendations, strength of Recommendation (as per Grading of Recommendations, Assessment, Development and Evaluations), and details of supporting evidence base. DATA SYNTHESIS: We identified three ventilation strategies that confer a mortality and morbidity benefit for ventilated patients with acute hypoxic respiratory failure: low-tidal volume ventilation, plateau pressures of less than 30 cm H(2)O, and higher positive end-expiratory pressure (PEEP). These moderate-to-strong recommendations were based on moderate-to-high certainty in evidence. We identified several other recommendations with no or minimal certainty in evidence. CONCLUSIONS: Our systematic review of international CPGs identified no recommendations favoring specific mode of ventilation and three ventilation strategies that confer mortality and morbidity benefits, backed by moderate-to-strong evidence. Ventilator design teams must include the ability to consistently provide and measure low-tidal volume ventilation, plateau pressures of less than 30 cm H(2)O, and higher PEEP into their designs. Based on our findings, we provide the first public framework for open-source ventilator design. Lippincott Williams & Wilkins 2022-07-18 /pmc/articles/PMC9249267/ /pubmed/35795401 http://dx.doi.org/10.1097/CCE.0000000000000723 Text en Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Systematic Review
Dave, Chintan
Sivajohan, Asaanth
Basmaji, John
Slessarev, Marat
Evidence-Based Considerations for the Design of an Open-Source Ventilator: A Systematic Review
title Evidence-Based Considerations for the Design of an Open-Source Ventilator: A Systematic Review
title_full Evidence-Based Considerations for the Design of an Open-Source Ventilator: A Systematic Review
title_fullStr Evidence-Based Considerations for the Design of an Open-Source Ventilator: A Systematic Review
title_full_unstemmed Evidence-Based Considerations for the Design of an Open-Source Ventilator: A Systematic Review
title_short Evidence-Based Considerations for the Design of an Open-Source Ventilator: A Systematic Review
title_sort evidence-based considerations for the design of an open-source ventilator: a systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9249267/
https://www.ncbi.nlm.nih.gov/pubmed/35795401
http://dx.doi.org/10.1097/CCE.0000000000000723
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