Innovative ventilation technologies used in the intensive care unit for adults and children: a scoping review [version 1; peer review: 2 approved with reservations]

Background: There is widespread interest in the use of innovative ventilation technologies to improve clinical outcomes across the 13–20 million people each year globally that receive invasive ventilation on an intensive care unit. This scoping review aims to summarise the volume and nature of evidence underpinning the use of 22 innovative ventilation technologies in adults and children.

Methods: We searched MEDLINE, EMBASE, Cochrane library and other key databases from 2010 to May 2024 for primary studies and systematic reviews that evaluated the use of 22 innovative ventilation technologies in adults and children requiring, or at risk of requiring, invasive ventilation. We defined an innovative ventilation technology as a ventilation approach not currently recommended by clinical guidelines due to lack of or uncertainty of evidence. We summarise findings as evidence maps.

Results: Our search identified 22,274 records of which we included 851 studies (564 primary studies; 277 systematic reviews; 10 economic evaluation studies). Over 50% of studies focussed on non-invasive respiratory support strategies to reduce the risk of a primary tracheal intubation (n=319, 37%) or re-intubation (n=130, 15%). We identified ten or fewer studies for seven technologies, including phrenic nerve stimulation, artificial intelligence, and ultra-low tidal volume ventilation. Few studies include children (n=128, 15%) or report patient-focussed outcomes (n=19, 2%).

Conclusions: For many technologies despite being used in clinical practice, the available evidence is currently inadequate to determine its clinical effectiveness, particularly in children. Key technologies need to be evaluated in high-quality multi-centre clinical trials that report patient-focussed outcomes.