CLOSED-LOOP VENTILATION AND OXYGENATION WITH DECISION SUPPORT FLUID RESUSCITATION TO TREAT MAJOR BURN INJURY WITH SMOKE-INDUCED ACUTE RESPIRATORY DISTRESS SYNDROME.

Summary

In a conscious ovine model of burn plus smoke–induced ARDS, automated control of FiO2/PEEP and ventilation with decision-support fluid resuscitation improved static compliance, lowered driving pressure, and increased survival compared with manual settings. The closed-loop strategy yielded a higher net fluid balance without adverse interaction with automated PEEP control.

Key Findings

• Closed-loop group had significantly higher PEEP and minute ventilation percentage and improved static lung compliance compared with controls.
• Driving pressure was significantly lower and survival rate was higher in the closed-loop group.
• Net fluid balance at 48 hours was higher with closed-loop control, without adverse interaction between automated PEEP and fluid management.

Clinical Implications

Supports feasibility of automated FiO2/PEEP titration during aggressive resuscitation after burns; motivates early-phase human feasibility/safety trials and integration of closed-loop control in ventilators.

Limitations

• Preclinical animal model limits external validity to human ICU settings
• Short observation window (48 hours) and small sample size (n=17) may overestimate effect sizes

Future Directions

Conduct human feasibility and safety trials of closed-loop FiO2/PEEP control with integrated fluid resuscitation decision support; evaluate longer-term outcomes and interaction with sedation, hemodynamics, and lung injury heterogeneity.