Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study

Détails

ID Serval
serval:BIB_F53F01DE8A80
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study
Périodique
Anesthesiology
Auteur⸱e⸱s
Sulzer  C. F., Chiolero  R., Chassot  P. G., Mueller  X. M., Revelly  J. P.
ISSN
0003-3022 (Print)
Statut éditorial
Publié
Date de publication
12/2001
Volume
95
Numéro
6
Pages
1339-45
Notes
Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't --- Old month value: Dec
Résumé
BACKGROUND: Adaptive support ventilation (ASV) is a microprocessor-controlled mode of mechanical ventilation that maintains a predefined minute ventilation with an optimal breathing pattern (tidal volume and rate) by automatically adapting inspiratory pressure and ventilator rate to changes in the patient's condition. The aim of the current study was to test the hypothesis that a protocol of respiratory weaning based on ASV could reduce the duration of tracheal intubation after uncomplicated cardiac surgery ("fast-track" surgery). METHODS: A group of patients being given ASV (group ASV) was compared with a control group (group control) in a randomized controlled study. After coronary artery bypass grafting during general anesthesia with midazolam and fentanyl, patients were randomly assigned to group ASV or group control. Both protocols were divided into three predefined phases, and weaning progressed according to arterial blood gas and clinical criteria. In phase 1, ASV mode was set at 100% of the theoretical value of volume/minute in group ASV, and synchronized intermittent mandatory ventilation mode was used in group control. When spontaneous breathing occurred, ASV setting was reduced by 50% of minute ventilation (phase 2) and again by 50% (phase 3), and the trachea was extubated. In group control, the ventilator was switched to 10 cm H2O inspiratory pressure support (phase 2), then to 5 cm H2O (phase 3) until extubation. RESULTS: Forty-nine patients were enrolled. Sixteen patients completed the ASV protocol, and 20 the standard protocol; 7 patients were excluded in group ASV and 6 in group control according to explicit, predefined criteria. There were no differences between groups in perioperative characteristics or in the doses of sedation. The primary outcome of the study, that is, the duration of tracheal intubation, was shorter in group ASV than in group control (median [quartiles]: 3.2 [2.5-4.6] vs. 4.1 [3.1-8.6] h; P < 0.02). Fewer arterial blood analyses were performed in group ASV (median number [quartiles]: 3 [3-4] vs. 4 [3-6]), suggesting that fewer changes in the settings of the ventilator were required in this group. CONCLUSIONS: A respiratory weaning protocol based on ASV is practicable; it may accelerate tracheal extubation and simplify ventilatory management in fast-track patients after cardiac surgery. The evaluation of potential advantages of the use of such technology on patient outcome and resource utilization deserves further studies.
Mots-clé
Aged *Cardiac Surgical Procedures Coronary Artery Bypass Female Hemodynamic Processes/physiology Humans *Intubation, Intratracheal Male Middle Aged *Respiration, Artificial Respiratory Mechanics/physiology Ventilator Weaning/*methods Ventilators, Mechanical
Pubmed
Web of science
Création de la notice
24/01/2008 18:03
Dernière modification de la notice
20/08/2019 17:22
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