Semiautonomous ventilation in a porcine hemorrhage and lung injury model provides lung protective ventilation.

Summary

In three porcine injury models, a physiologic closed-loop ventilator increased the proportion of time within target oxygenation (SpO2) versus standard care while maintaining ARDSNet-concordant tidal volumes and plateau pressures. Benefits were pronounced in hemorrhage, suggesting robustness in hemodynamic instability.

Key Findings

• Across all models, PCLC increased time within target SpO2 versus SOC (68% ± 24% vs 49% ± 25%, p=0.04).
• In hemorrhage alone, PCLC achieved higher target SpO2 time than SOC (p=0.01).
• ARDSNet-concordant tidal volume and plateau pressure targets were comparable between groups; no deterioration with PCLC.

Clinical Implications

Closed-loop ventilation could reduce hypoxemia and maintain lung-protective targets with less clinician input, supporting scalable critical care in low-resource settings; human clinical trials are needed.

Limitations

• Preclinical porcine model; human generalizability uncertain
• Sample size modest (n=30) with limited duration monitoring; randomization/blinding not detailed

Future Directions

Prospective human feasibility and safety trials in ICU and transport settings; integration with multi-organ closed-loop systems and evaluation in ARDS patients.