Clinical experience with adaptive support ventilation for fast-track cardiac surgery.
OBJECTIVE
To evaluate adaptive support ventilation (ASV), an automatic microprocessor-controlled mode of mechanical ventilation, for the initial ventilatory management in consecutive patients eligible for early extubation after cardiac surgery.


METHODS
Prospective observational study.


METHODS
Nonuniversity cardiac center.


METHODS
One hundred fifty-five consecutive patients eligible for early tracheal extubation after cardiac surgery.


METHODS
On intensive care unit arrival, patients were ventilated by adaptive support ventilation. This mode provided an automatic selection of initial ventilatory parameters and a continuous adaptation to patient's respiratory activity, guaranteeing that a preset minute ventilation was delivered. Once the patients had recovered sustained spontaneous ventilation, the ventilator was switched manually to pressure support for the terminal part of respiratory weaning followed by extubation.


RESULTS
In adaptive support ventilation, all patients could be ventilated satisfactorily except 1; tidal volume was 8.7 +/- 1.4 mL/kg of ideal body weight (mean +/- SD), plateau pressure was 20.3 +/- 3.9 cmH(2)O, and arterial blood gas measurements were satisfactory. One hundred thirty-four patients (86%) were extubated within 6 hours, and intubation time was 3.6 (2.53-4.83) hours (median, [quartiles]). No reintubation because of respiratory failure was required. Adaptive support ventilation was considered easy to use by both the nurses and physicians.


CONCLUSIONS
Adaptive support ventilation was used in a group of 155 consecutive patients after fast-track cardiac surgery. This ventilation mode was safe, easy to apply, and allowed rapid extubation in suitable patients. ASV may facilitate postoperative respiratory management.
Cassina
Tiziano
T
Anaesthesia/Intensive Care Unit, Department of Carsiovascular Ticino, Lugano, Switzerland.
Chioléro
René
R
Mauri
Romano
R
Revelly
Jean-Pierre
JP
D000368:Aged; D001784:Blood Gas Analysis; D006348:Cardiac Surgical Procedures; D005260:Female; D006331:Heart Diseases / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D001239:Inhalation / Q000502:physiology; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D012121:Respiration, Artificial; D013990:Tidal Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome