| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
*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.
This article has been cited by other articles:
|
|
 |
|
  E. MIRELES-CABODEVILA, E. DIAZ-GUZMAN, G. A. HERESI, and R. L. CHATBURN Alternative modes of mechanical ventilation: A review for the hospitalist Cleveland Clinic Journal of Medicine, July 1, 2009; 76(7): 417 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Dongelmans, D. P. Veelo, F. Paulus, B. A. J. M. de Mol, J. C. Korevaar, A. Kudoga, P. Middelhoek, J. M. Binnekade, and M. J. Schultz Weaning Automation with Adaptive Support Ventilation: A Randomized Controlled Trial in Cardiothoracic Surgery Patients Anesth. Analg., February 1, 2009; 108(2): 565 - 571. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. P. Veelo, D. A. Dongelmans, P. Middelhoek, J. C. Korevaar, and M. J. Schultz Adaptive Support Ventilation with Percutaneous Dilatational Tracheotomy: A Clinical Study Anesth. Analg., September 1, 2008; 107(3): 938 - 940. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. MacIntyre Discontinuing Mechanical Ventilatory Support Chest, September 1, 2007; 132(3): 1049 - 1056. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J-M. Boles, J. Bion, A. Connors, M. Herridge, B. Marsh, C. Melot, R. Pearl, H. Silverman, M. Stanchina, A. Vieillard-Baron, et al. Weaning from mechanical ventilation Eur. Respir. J., May 1, 2007; 29(5): 1033 - 1056. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. D. Macnaughton New ventilators for the ICU--usefulness of lung performance reporting Br. J. Anaesth., July 1, 2006; 97(1): 57 - 63. [Abstract] [Full Text] [PDF]
|
|
|
