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CRITICAL CARE AND TRAUMA

Automatic "Respirator/Weaning" with Adaptive Support Ventilation: The Effect on Duration of Endotracheal Intubation and Patient Management

Alexander H. Petter, MD^*, René L. Chioléro, MD^*, Tiziano Cassina, MD^*, Pierre-Guy Chassot, MD, Xavier M. Müller, MD, and Jean-Pierre Revelly, MD^*

*Surgical Intensive Care Unit, Department of Anesthesiology, and Department of Cardiac Surgery, University Hospital, Lausanne, Switzerland

Address correspondence and reprint requests to Jean-Pierre Revelly, MD, Surgical Intensive Care Unit, Room 08.652, Lausanne University Hospital, CH-1011-Lausanne, Switzerland. Address e-mail to jrevelly{at}chuv.hospvd.ch

Adaptive support ventilation (ASV) provides an automatic adaptation of the ventilator settings to patient’s passive and active respiratory mechanics. In a randomized controlled study, we evaluated automatic respiratory weaning in ASV for early tracheal extubation after cardiac surgery. Eligible patients were assigned to either an ASV protocol or a standard one consisting of synchronized intermittent ventilation followed by pressure support. Eighteen patients completed the ASV protocol, and 16 completed the standard one. There were no differences between groups in perioperative characteristics, lengths of tracheal intubation and intensive care unit stay, and ventilatory variables, except less peak inspiratory pressure during the initial phase in ASV (17.5 ± 0.8 versus 22.2 ± 0.8 cm H₂O; P < 0.01). ASV patients required fewer ventilatory settings manipulations (2.4 ± 0.7 versus 4.0 ± 0.8 manipulations per patient; P < 0.05) and endured less high-inspiratory pressure alarms (0.7 ± 2.4 versus 2.9 ± 3.0; P < 0.05). These results suggest that in this specific population of patients, automation of postoperative ventilation with ASV resulted in an outcome similar to the control group. The internal logic of the new device resulted in less manipulation of the setting and alarms that could simplify respiratory management.

IMPLICATIONS: Adaptive support ventilation (ASV), a ventilatory mode providing automatic adjustment of the settings was compared with standard management for rapid tracheal extubation after cardiac surgery. The two approaches were equal in terms of outcome. In ASV, we observed fewer ventilator settings manipulations and a smaller amount of alarms, suggesting that this automatic mode may simplify postoperative respiratory management without delaying extubation.

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