Automatic “Respirator/Weaning” with Adaptive Support Ventilation: The Effect on Duration of Endotracheal Intubation and Patient Management

Petter, Alexander H.; Chioléro, René; Cassina, Tiziano; Chassot, Pierre‐Guy; Müller, Xavier M.; Revelly, Jean-Pierre

doi:10.1213/01.ane.0000086728.36285.be

Cited by 95 publications

(69 citation statements)

References 24 publications

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“…SULZER et al [9] reported shorter duration of intubation and mechanical ventilation with ASV than synchronised intermittent mandatory ventilation (SIMV) in post-operative coronary bypass patients. CASSINA et al [5] used ASV when weaning 155 cardiac surgery patients; 86% were extubated within 6 h and the mean time to extubation was 3.6 h. In a randomised controlled trial, PETTER et al [10] compared ASV with SIMV+PSV when weaning 45 cardiac surgery patients and found that the duration of mechanical ventilation and the need for changing the ventilator settings were reduced with ASV. These findings suggest that ASV could be used for fast and early extubation after post-cardiac surgery.…”

Section: Weaning Durationmentioning

confidence: 99%

“…Adaptive support ventilation (ASV) is an improved closed-loop ventilation mode that provides both pressure-controlled ventilation and PSV according to the patient's needs [9][10][11][12]. Some studies have evaluated the use of ASV in weaning cardiac surgery patients and have shown a reduction in weaning time, a reduced need for arterial blood gas (ABG) analyses, and fewer ventilator adjustments [9,10,13,14].…”

mentioning

confidence: 99%

“…Some studies have evaluated the use of ASV in weaning cardiac surgery patients and have shown a reduction in weaning time, a reduced need for arterial blood gas (ABG) analyses, and fewer ventilator adjustments [9,10,13,14]. The use of ASV in patients with COPD has been described previously [12,15], but only one study reported the use of ASV as a weaning mode for chronically ventilated patients, some of whom had COPD [16].…”

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confidence: 99%

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Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

et al. 2011

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Adaptive support ventilation (ASV) is a closed-loop ventilation mode that can act both as pressure support ventilation (PSV) and pressure-controlled ventilation. Weaning with ASV shows promising results, mainly in post-cardiac surgery patients. The aim of the present randomised controlled study was to test the hypothesis that weaning with ASV could reduce the weaning duration in patients with chronic obstructive pulmonary disease (COPD) when compared with PSV.From among 435 COPD patients admitted to the intensive care unit (ICU) during a 20-month period, 97 were enrolled. Patients were assigned at random to either ASV or PSV as a weaning mode.Compared with PSV, ASV provided shorter weaning times (median 24 (interquartile range 20-62) h versus 72 (24-144) h, p50.041) with similar weaning success rates (35 out of 49 for ASV and 33 out of 48 for PSV). Length of stay in the ICU was also shorter with ASV but the difference was not statistically significant.This study suggests that ASV may be used in the weaning of COPD patients with the advantage of shorter weaning times. Further studies are needed to investigate the role and potential advantages of ASV in the weaning period of different patient groups.

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Section: Weaning Durationmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

et al. 2011

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“…Clinical studies found that post-cardiac-surgery patients ventilated with ASV had either shorter or equivalent time to extubation. [8][9][10][11][12] ASV may also decrease inspiratory load, improve patient-ventilator interaction, 13 and decrease the need to adjust ventilator settings. 9 On the other hand, an inappropriate %MinVol setting may adversely affect the progress of ventilator weaning.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11][12] ASV may also decrease inspiratory load, improve patient-ventilator interaction, 13 and decrease the need to adjust ventilator settings. 9 On the other hand, an inappropriate %MinVol setting may adversely affect the progress of ventilator weaning. Too high a %MinVol setting that excessively reduces the work of breathing and respiratory drive may lead to muscle atrophy and weakness, whereas too low a %Min-Vol setting may increase patient anxiety and work of breathing.…”

Section: Introductionmentioning

confidence: 99%

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

Chen

Dai

et al. 2011

Respir Care

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BACKGROUND: Adaptive support ventilation (ASV) facilitates ventilator liberation in postoperative patients in surgical intensive care units (ICU).Whether ASV has similar benefits in patients with acute respiratory failure is unclear. METHODS: We conducted a pilot study in a medical ICU that manages approximately 600 mechanically ventilated patients a year. The ICU has one respiratory therapist who manages ventilators twice during the day shift (8:00 AM to 5:00 PM). No on-site respiratory therapist was present at night. We prospectively enrolled 79 patients mechanically ventilated for > 24 hours on pressure support of > 15 cm H 2 O, with or without synchronized intermittent mandatory ventilation, F IO 2 < 50%, and PEEP < 8 cm H 2 O. We switched the ventilation mode to ASV starting at a "%MinVol" setting of 80 -100%. We defined spontaneous breathing trial (SBT) readiness as a frequency/tidal-volume ratio of < 105 (breaths/min)/L on pressure support of < 8 cm H 2 O and PEEP of < 5 cm H 2 O for at least 2 h, and all spontaneous breaths. The T-piece SBT was considered successful if the frequency/tidal-volume ratio remained below 105 (breaths/min)/L for 30 min, and we extubated after successful SBT. The control group consisted of 70 patients managed with conventional ventilation modes and a ventilator protocol during a 6-month period immediately before the ASV study period. RESULTS: Extubation was attempted in 73% of the patients in the ASV group, and 80% of the patients in the non-ASV group. The re-intubation rates in the ASV and non-ASV groups were 5% and 7%, respectively. In the ASV group, 20% of the patients achieved extubation readiness within 1 day, compared to 4% in the non-ASV group (P ‫؍‬ <.001). The median time from the enrollment to extubation readiness was 1 day for the ASV group and 3 days for the non-ASV group (P ‫؍‬ .055). Patients switched to ASV were more likely to be liberated from mechanical ventilation at 3 weeks (P ‫؍‬ .04). Multiple logistic regression analysis showed that, of the independent factors in the model, only ASV was associated with shorter time to extubation readiness (P ‫؍‬ .048 via likelihood ratio test). CONCLUSIONS: Extubation readiness may not be recognized in a timely manner in at least 15% of patients recovering from respiratory failure. ASV helps to identify these patients and may improve their weaning outcomes.

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Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children

Rose¹,

Schultz²,

Cardwell³

et al. 2011

Cochrane Database of Systematic Reviews

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Automatic “Respirator/Weaning” with Adaptive Support Ventilation: The Effect on Duration of Endotracheal Intubation and Patient Management

Cited by 95 publications

References 24 publications

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

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

Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children

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