title: Adaptive support ventilation with protocolized de-escalation and escalation does not accelerate tracheal extubation of patients after nonfast-track cardiothoracic surgery.
abstract: 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.
authors.affiliation: Department of Intensive Care Medicine, G3-212, Academic Medical Center, Amsterdam, The Netherlands. D.A.Dongelmans@amc.uva.nz
authors.forename: Dave A
authors.initials: DA
authors.lastname: Dongelmans
authors.forename: Denise P
authors.initials: DP
authors.lastname: Veelo
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: Bas A J M
authors.initials: BA
authors.lastname: de Mol
authors.forename: Anna
authors.initials: A
authors.lastname: Kudoga
authors.forename: Frederique
authors.initials: F
authors.lastname: Paulus
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000639:trends; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods* / Q000639:trends; D012121:Respiration, Artificial / Q000379:methods* / Q000639:trends; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods* / Q000639:trends