title: Automatic versus manual pressure support reduction in the weaning of post-operative patients: a randomised controlled trial.
abstract: BACKGROUND
  Reduction of automatic pressure support based on a target respiratory frequency or mandatory rate ventilation (MRV) is available in the Taema-Horus ventilator for the weaning process in the intensive care unit (ICU) setting. We hypothesised that MRV is as effective as manual weaning in post-operative ICU patients.
  
  
  METHODS
  There were 106 patients selected in the post-operative period in a prospective, randomised, controlled protocol. When the patients arrived at the ICU after surgery, they were randomly assigned to either: traditional weaning, consisting of the manual reduction of pressure support every 30 minutes, keeping the respiratory rate/tidal volume (RR/TV) below 80 L until 5 to 7 cmH2O of pressure support ventilation (PSV); or automatic weaning, referring to MRV set with a respiratory frequency target of 15 breaths per minute (the ventilator automatically decreased the PSV level by 1 cmH2O every four respiratory cycles, if the patient's RR was less than 15 per minute). The primary endpoint of the study was the duration of the weaning process. Secondary endpoints were levels of pressure support, RR, TV (mL), RR/TV, positive end expiratory pressure levels, FiO2 and SpO2 required during the weaning process, the need for reintubation and the need for non-invasive ventilation in the 48 hours after extubation.
  
  
  RESULTS
  In the intention to treat analysis there were no statistically significant differences between the 53 patients selected for each group regarding gender (p = 0.541), age (p = 0.585) and type of surgery (p = 0.172). Nineteen patients presented complications during the trial (4 in the PSV manual group and 15 in the MRV automatic group, p < 0.05). Nine patients in the automatic group did not adapt to the MRV mode. The mean +/- sd (standard deviation) duration of the weaning process was 221 +/- 192 for the manual group, and 271 +/- 369 minutes for the automatic group (p = 0.375). PSV levels were significantly higher in MRV compared with that of the PSV manual reduction (p < 0.05). Reintubation was not required in either group. Non-invasive ventilation was necessary for two patients, in the manual group after cardiac surgery (p = 0.51).
  
  
  CONCLUSIONS
  The duration of the automatic reduction of pressure support was similar to the manual one in the post-operative period in the ICU, but presented more complications, especially no adaptation to the MRV algorithm.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  ISRCTN37456640.
authors.affiliation: Adult - ICU - Albert Einstein Hospital, Brazil. corinnetani@yahoo.com.br
authors.forename: Corinne
authors.initials: C
authors.lastname: Taniguchi
authors.forename: Raquel C
authors.initials: RC
authors.lastname: Eid
authors.forename: Cilene
authors.initials: C
authors.lastname: Saghabi
authors.forename: Rogério
authors.initials: R
authors.lastname: Souza
authors.forename: Eliezer
authors.initials: E
authors.lastname: Silva
authors.forename: Elias
authors.initials: E
authors.lastname: Knobel
authors.forename: Angela T
authors.initials: AT
authors.lastname: Paes
authors.forename: Carmen S
authors.initials: CS
authors.lastname: Barbas
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D011182:Postoperative Care / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D013990:Tidal Volume / Q000502:physiology; D015300:Ventilator Weaning / Q000295:instrumentation / Q000379:methods*