Adaptive support ventilation with protocolized de-escalation and escalation does not accelerate tracheal extubation of patients after nonfast-track cardiothoracic surgery.
BACKGROUND
It is uncertain whether adaptive support ventilation (ASV) accelerates weaning of nonfast-track cardiothoracic surgery patients. A lower operator set %-minute ventilation with ASV may allow for an earlier definite switch from controlled to assisted ventilation, potentially hastening tracheal extubation. We hypothesized that ASV using protocolized de-escalation and escalation of operator set %-minute ventilation (ASV-DE) reduces time until tracheal extubation compared with ASV using a fixed operator set %-minute ventilation (standard ASV) in uncomplicated patients after nonfast-track coronary artery bypass graft.


METHODS
We performed a randomized controlled trial comparing ASV-DE with standard ASV. With ASV-DE, as soon as body temperature was >35.0°C with pH >7.25, operator set %-minute ventilation was decreased stepwise to a minimum of 70%.


RESULTS
Sixty-three patients were randomized to ASV-DE, and 63 patients to standard ASV. The duration of mechanical ventilation was not different between groups (10.8 [6.5-16.1] vs 10.7 [6.6-13.9] hours, ASV-DE versus standard ASV; P = 0.32). Time until the first assisted breathing period was shorter (3.1 [2.0-6.7] vs 3.9 [2.1-7.5] hours) and the number of assisted ventilation episodes was higher (78 [34-176] vs 57 [32-116] episodes), but differences did not reach statistical significance. The duration of assisted ventilation episodes that ended with tracheal extubation was different between groups (2.5 [0.9-4.6] vs 1.4 [0.3-3.5] hours, ASV-DE versus standard ASV; P < 0.05).


CONCLUSIONS
Compared with standard ASV, weaning of patients after nonfast-track coronary artery bypass graft using ASV with protocolized de-escalation and escalation does not shorten time to tracheal extubation.
Dongelmans
Dave A
DA
Department of Intensive Care Medicine, G3-212, Academic Medical Center, Amsterdam, The Netherlands. D.A.Dongelmans@amc.uva.nz
Veelo
Denise P
DP
Binnekade
Jan M
JM
de Mol
Bas A J M
BA
Kudoga
Anna
A
Paulus
Frederique
F
Schultz
Marcus J
MJ
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