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CRITICAL CARE AND TRAUMA

Adaptive Support Ventilation with Percutaneous Dilatational Tracheotomy: A Clinical Study

Denise P. Veelo, MD^*, Dave A. Dongelmans, MD^*, Pauline Middelhoek, RN^*, Johanna C. Korevaar, PhD, and Marcus J. Schultz, MD, PhD^*

From the Departments of *Intensive Care Medicine; Anesthesiology; Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and HERMES Critical Care Group, Amsterdam, The Netherlands.

We determined the need for changes in minute ventilation with adaptive support ventilation after percutaneous dilatational tracheotomy under endoscopic guidance in 34 intensive care unit patients. During the procedure, minute ventilation was not changed; only maximum pressure limits were adjusted, if necessary. After insertion of the tracheotomy, cannula minute ventilation was adjusted only if Paco₂-values changed 0.5 kPa from baseline. In 74% of patients, adaptive support ventilation was unable to maintain minute ventilation during the use of the endoscope, mandating pressure limitation adjustments. In a minority of patients (26%), minute ventilation had to be adjusted to achieve similar Paco₂ values.