A Randomized Controlled Trial of Adaptive Support Ventilation Mode to Wean Patients after Fast-track Cardiac Valvular Surgery

Zhu, Fang; Gomersall, Charles D; Ng, SM; Underwood, Malcolm J.; Lee, Anna

doi:10.1097/aln.0000000000000589

Cited by 43 publications

(46 citation statements)

References 26 publications

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“…In this meta-analysis, in terms of effectiveness, early tracheal extubation can signi cantly reduce the length of stay in ICU and slightly reduced the average hospital stays. As for security, compared with previous meta-analysis [11,13], the risk of re-intubation in the early extubation group is signi cantly higher than in the conventional extubation group. Seven of the ten studies reporting re-intubation risk reported a higher risk of extubation than the conventional extubation group.…”

Section: Discussionmentioning

confidence: 68%

Early Tracheal Extubation for Postoperative Recovery in Cardiac Surgery: Systematic Review and Meta-Analysis

Zhao

Huang

Chao

et al. 2020

Preprint

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Background: How to promote the rapid recovery of patients undergoing cardiac surgery and quality of life has been the focus of doctors’ attention. To compare the safety and efficacy of early cardiac extubation with conventional extubation (late extubation) in patients undergoing cardiac surgery.Methods: Ovid MEDLINE, Ovid Embase, EBSCOhost, Cochrane Library and ISIWeb of Science (1946–November 25, 2019) were searched to obtain randomized controlled trials of early tracheal extubation in patients undergoing cardiac surgery.Results: Compared with the conventional care group, in terms of effectiveness, the intensive care unit (ICU) stay and hospital length of stay in the early tracheal extubation was significantly shorter. In terms of security, most outcomes, including mortality, bleeding, stroke, acute renal failure and arrhythmia, were not statistically significant, except for myocardial infarction. However, the risk of re-intubation in the early tracheal extubation was higher than that of conventional extubation.Conclusions: This meta-analysis confirmed that early tracheal extubation may effectively reduce ICU hospitalization time, hospital length of stay and the risk of myocardial infarction. Although early tracheal extubation does not increase the risk of safety events, the clinicians need to pay more attention to be aware of possible risk of re-intubation. Meanwhile, as a key time point for extubation within 4 hours, it may help a little to reduce the risk of re-intubation and myocardial infarction.

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Section: Discussionmentioning

confidence: 68%

Early Tracheal Extubation for Postoperative Recovery in Cardiac Surgery: Systematic Review and Meta-Analysis

Zhao

Huang

Chao

et al. 2020

Preprint

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“…[13] Other pressure modes of mechanical ventilation may have better patient-ventilator synchrony and adequate gas exchange and less ventilator-induced lung injury. [5141516]…”

Section: Discussionmentioning

confidence: 99%

Comparison of respiratory and hemodynamic stability in patients with traumatic brain injury ventilated by two ventilator modes: Pressure regulated volume control versus synchronized intermittent mechanical ventilation

2016

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Background:This study aimed to compare pressure regulated volume control (PRVC) and synchronized intermittent mechanical ventilation (SIMV) modes of ventilation according to respiratory and hemodynamic stability in patients with traumatic brain injury (TBI) admitted to Intensive Care Unit (ICU).Materials and Methods:In a randomized, single-blinded, clinical trial study, 100 patients who hospitalized in ICU due to TBI were selected and randomly divided into two groups. The first and second groups were ventilated by PRVC and SIMV modes, respectively. During mechanical ventilation, arterial blood gas and respiratory and hemodynamic parameters were also recorded and compared between the two groups.Results:According to the t-test, the mean rapid shallow breathing index (RSBI) after the first 8 h of mechanical ventilation was significantly higher in SIMV group compared with PRVC group (107.6 ± 2.75 vs. 102.2 ± 5.2, respectively, P < 0.0001). Further, according to ANOVA with repeated measures, the trend of RSBI changes had a significant difference between the two groups (P < 0.001). The trend of ratio of partial pressure arterial oxygen and fraction of inspired oxygen was different between the two groups according to Mann–Whitney–Wilcoxon test (P < 0.001).Conclusions:Using PRVC mode might be more desirable than using SIMV mode in patients with TBI due to better stability of ventilation and oxygenating. To ensure for more advantages of PRVC mode, further studies with longer follow-up and more detailed measurements are recommended.

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“…In the study by Zhu et al . 1 on adaptive support ventilation, the compared postoperatively physician-controlled ventilation using synchronized intermittent mandatory ventilation with pressure support to closed-loop adaptive support ventilation in patients undergoing fast-track cardiac valvular surgery. Adaptive support ventilation significantly decreased weaning time in these patients by more than 2 h. This was a randomized unblinded trial of patients in a single hospital, and the sample size was modest.…”

Section: Modes Of Mechanical Ventilationmentioning

confidence: 99%

“…Adaptive support ventilation significantly decreased weaning time in these patients by more than 2 h. This was a randomized unblinded trial of patients in a single hospital, and the sample size was modest. Nonetheless, the adaptive support ventilation, a “closed-loop mode, where the ventilator computer adjusts the inspiratory pressure to a tidal volume that minimizes the work of breathing and switches between control and support breaths based on the absence or presence of spontaneous breath efforts,” 1 was superior in getting patients’ tracheas extubated faster, without increasing complications, including reintubations. Once again, physicians are documented to be less efficient than a protocol 2 and as noted by the authors, synchronized intermittent mandatory ventilation has never been documented to be a superior mode of ventilation.…”

Section: Modes Of Mechanical Ventilationmentioning

confidence: 99%

New Investigations of Core Competencies

Wiener-Kronish

Melo

2015

Anesthesiology

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A Randomized Controlled Trial of Adaptive Support Ventilation Mode to Wean Patients after Fast-track Cardiac Valvular Surgery

Abstract: Adaptive support ventilation reduces ventilation time by more than 2 h in patients who have undergone fast-track cardiac valvular surgery while reducing the number of manual ventilator changes and alarms.

Cited by 43 publications

References 26 publications

Early Tracheal Extubation for Postoperative Recovery in Cardiac Surgery: Systematic Review and Meta-Analysis

Early Tracheal Extubation for Postoperative Recovery in Cardiac Surgery: Systematic Review and Meta-Analysis

Comparison of respiratory and hemodynamic stability in patients with traumatic brain injury ventilated by two ventilator modes: Pressure regulated volume control versus synchronized intermittent mechanical ventilation

New Investigations of Core Competencies

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