A randomized trial of automated versus conventional protocol-driven weaning from mechanical ventilation following coronary artery bypass surgery☆

Abstract

Automode ventilator weaning trended toward more rapid extubation than did conventional protocol-driven ventilation in conjunction with a standardized weaning protocol. Physiologic and hemodynamic factors were better in patients using automode ventilation compared to patients using conventional ventilation. Automode ventilation was well tolerated and did not induce significant adverse effects.

Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery

“…[7][8][9][10][11] Mechanical ventilation was routinely applied after CABG to reduce the power consumption of the respiratory system and the cardiac burden to improve postoperative cardiac recovery. [12][13][14] Due to a system of risk factors (such as the duration of surgery, anesthesia, clinical condition, mode of ventilator therapy, and method of weaning from mechanical ventilation), many patients should receive prolonged mechanical ventilation. [15][16][17] It was reported that the prolonged mechanical ventilation could prolong the hospital and intensive care unit (ICU) stay, 18) increase the burden of patients, and raise the risk of cerebral palsy, postoperative atrial fibrillation or ventilator-associated pneumonia.…”

Reply to Schädler et al.

“…The criticism that automode only enables ventilation with either mandatory ventilation or assisted spontaneous ventilation [1] is not correct, instead automode ventilation is a dynamic process. Mechanical ventilation mode automatically changes modes back and forth between mandatory mechanical ventilation and spontaneous ventilation, depending on the patients' alertness [2]. Comparing the cited literature [3,4] as well as the references we presented, the statements of all these studies, including the statement of our study, are similar.…”

“…More up-to-date methods for automated weaning like adaptive support ventilation (Galileo, Hamilton Medical, Bonaduz, Switzerland) [3] or SmartCare/PS (Evita XL, Dräger Medical, Lübeck, Germany), aimed at decreasing the work of breathing and keeping the patient in a zone of respiratory comfort, were shown to significantly decrease the weaning time [4,5]. In this respect the results presented by Hendrix We read with interest the letter to the editor by Schädler et al [1] with their comments on our recent article of automated weaning patients from mechanical ventilation using the Siemens 300 A ventilator [2]. We would like to respond on these comments.…”

Effects of Implementing Adaptive Support Ventilation in a Medical Intensive Care Unit

“…21 Various computerized algorithms have been used to assist weaning, and most of those studies showed promise in shortening time to extubation. 9,10,12,[22][23][24] But the superior results with computerized algorithms in those studies appeared to be due in part to slower weaning in the control group, dictated by the study protocol. In clinical practice slower weaning can be due to system factors such as adequacy of staffing relative to clinical work load and the staff training and experience.…”