A Randomized Controlled Trial to Compare Adaptive Support Ventilation and Pressure Support Ventilation for Weaning COPD Patients

Title: A Randomized Controlled Trial to Compare Adaptive Support Ventilation and Pressure Support Ventilation for Weaning COPD Patients

Authors: Fayed AM, Megahed MM, El-Bourini MS

DOI: http://dx.doi.org/10.18535/jmscr/v4i8.32

Abstract

References

Corresponding Author

Abstract

Patients with COPD are frequently hospitalized for acute exacerbations (AECOPD), which may cause respiratory failure. Adaptive support ventilation (ASV) is an automatic system of ventilation, where it determines target minute ventilation based on the principle proposed by Otis et al. Weaning with ASV shows promising results, mainly in post cardiac surgery patients.

Objective: Our study was designed to compare ASV with PSV in the weaning of AECOPD patients

Methods: The study was conducted on 60 mechanically ventilated AECOPD patients admitted to the Department of Critical Care Medicine, at the Alexandria Main University Hospital. Exclusion criteria included those with severe cardiac or neurological disease, those managed by non-invasive ventilation and those on tracheostomy tube. All patients were subjected on admission to complete history taking, complete physical examination and Laboratory investigations and were treated according to guidelines of treatment of AECOPD. At the time of weaning patients were randomly divided into two equal groups; Group A: patients weaned using ASV and Group B: patients weaned using PSV.

Results: Weaning duration was significantly shorter with ASV versus PSV [median (IQR) 24 (12-48) h versus 72 (24-144) h, p < 0.001]. Success rates were [(93.3%) for ASV and (70%) in PSV group B (p = 0.042)]. Length of stay in the ICU was also significantly shorter with ASV (p = 0.001).

Conclusion: ASV may be used in the weaning of AECOPD patients with the advantage of shorter weaning times and hospital stay.

Keywords: Acute exacerbation of COPD, Adaptive support ventilation, Intensive care unit, Pressure support ventilation, Work of breathing, weaning success.

References

1. Gunen H, Hacievliyagil SS, Kosar F, Gulbas G, et al. Factors affecting survival of hospitalized patients with COPD. Eur Respir J 2005; 26:234

2. Patil, SP, Krishnan, JA, Lechtzin, N, Diette, GB. In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. Arch Intern Med 2003; 163:1180.

3. Seneff MG, Wagner DP, Wagner RP, Zimmerman JE, et al. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA 1995; 274:1852.

4. Breen, D, Churches, T, Hawker, F, Torzillo, PJ. Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: a long term follow up study. Thorax 2002; 57:29.

5. Snider, GL. Nosology for our day: its application to chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008; 167:678.

6. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: Executive summary 2013. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Available at: www.goldcopd.org.

7. Boles JM, Bion J, Connors A, Herridge M, et al. Weaning from mechanical ventilation. Eur Respir J 2007; 29: 1043.

8. Brochard L, Rauss A, Benito S, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994; 150: 896–903.

9. Esteban A, Frutos F, Tobin MJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 1995; 332: 345–50.

10. Laubscher TP, Heinrichs W, Weiler N, Hartmann G, et al. An adaptive lung ventilation controller. IEEE Trans Biomed Eng 1994; 41:51-9.

11. Laubscher TP, Frutiger A, Fanconi S, Brunner JX. The automatic selection of ventilation parameters during the initial phase of mechanical ventilation. Intensive Care Med 1996; 22(3):199-207.

12. Brunner JX. Principles and history of closed-loop controlled ventilation. Respir Care Clin N Am 2001; 7(3):341-62.

13. Brunner JX, Iotti GA. Adaptive support ventilation (ASV). Minerva Anestesiol 2002; 68(5):365-68.

14. Campbell RS, Branson RD, Johannigman JA. Adaptive support ventilation. Respir Care Clin N Am 2001; 7(3):425-40.

15. Sulzer CF, Chiolero R, Chassot PG, et al. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology 2001; 95: 1339–45.

16. Petter AH, Chiolero RL, Cassina T, et al. Automatic "respirator/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management. Anesth Analg 2003; 97: 1743–50.

17. Dongelmans DA, Veelo DP, Paulus F, et al. Weaning automation with adaptive support ventilation: a randomized controlled trial in cardiothoracic surgery patients. Anesth Analg 2009; 108: 565–71.

18. Gruber PC, Gomersall CD, Leung P, et al. Randomized controlled trial comparing adaptive-support ventilation with pressure-regulated volume-controlled ventilation with auto mode in weaning patients after cardiac surgery. Anesthesiology 2008; 109: 81–7.

19. Tassaux D, Dalmas E, Gratadour P, et al. Patient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support. Crit Care Med 2002; 30: 801–7.

20. Arnal JM, Wysocki M, Nafati C, et al. Automatic selection of breathing pattern using adaptive support ventilation. Intensive Care Med 2008; 34: 75–81.

21. Linton DM, Renov G, Lafair J, et al. Adaptive support ventilation as the sole mode of ventilatory support in chronically ventilated patients. Crit Care Resusc 2006; 8: 11–4.

22. Asia-Pacific COPD Roundtable Group. Global Initiative for Chronic Obstructive Lung Disease strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: an Asia-Pacific perspective. Respirology 2005; 10: 9–17.

23. Celli BR. Standards for the optimal management of COPD. Chest 1998; 113:283-7.

24. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine 1995; 152:77-120.

25. Peter B. Bach, Cynthia Brown, Sarah E. Gelfand, and Douglas C. McCrory. Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence. Annals of Internal Medicine 2001; 134(7):600-20.

26. Pauwels RA, Löfdahl CG, Postma DS, Tattersfield AE, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. American Journal of Respiratory and Crit Care Med 2001; 163(5):1256-76.

27. Krieger, BP, Ershowsky, PF, Becker, DA, Gazeroglu, HB. Evaluation of conventional criteria for predicting successful weaning from mechanical ventilatory support in elderly patients. Crit Care Med 1989; 17:858.

28. Tobin MJ, Perez W, Guenther SM, Semmes BJ, et al. The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dis 1986; 134:1111.

29. Otis AB, Fenn WO, Rahn H. Mechanics of breathing in man. J Appl Physiol 1950; 2: 592–607.

30. Brunner JX, Laubscher TP, Banner MJ, et al. Simple method to measure total expiratory time constant based on the passive expiratory flow-volume curve. Crit Care Med 1995; 23: 1117–22.

31. Lourens MS, van den Berg B, Aerts JG, et al. Expiratory time constants in mechanically ventilated patients with and without COPD. Intensive Care Med 2000; 26: 1612–18.

32. Branson R, Johannigman J, Cambell R, Davis K. Closed-loop Mechanical Ventilation. Respiratory Care 2002; 47(4):427-35.

33. American Association for Respiratory Care (AARC). Removal of the endotracheal tube--2007 revision & update. Respir Care 2007 Jan; 52(1):81-93.

34. Adapted from University of Virginia Health System MICU weaning protocol (Available @:www.nursingvirginia.edu/weaningprotoc-ol.html).

35. Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet 2009; 374: 250–9.

36. Hilbert G, Gruson D, Portel L, et al. Noninvasive pressure support ventilation in COPD patients with post extubation hypercapnic respiratory insufficiency. Eur Respir J 1998; 11: 1349–53.

37. Ferrer M, Valencia M, Nicolas JM, et al. Bernadich early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med 2006; 173: 164–70.

38. Puri BK. SPSS in Practice, an Illustrated Guide: Arnold, London, 2002; pp 320.

39. Kirakli C, Ozdemir I, Ucar Z.Z, Cimen P, et al. Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial. Eur Respir J 2011; 38:774-80.

40. Cassina T, Chiolero R, Mauri R, et al. Clinical experience with adaptive support ventilation for fast-track cardiac surgery. J Cardiothorac Vasc Anesth 2003; 17: 571–5.

41. Vitacca M, Vianello A, Colombo D, et al. Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days. Am J Respir Crit Care Med 2001; 164: 225–30.

42. Hess D. Ventilator modes used in weaning. Chest 2001; 120: Suppl.6, 474–6.

43. Esteban A, Alia I, Gordo F, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 1997; 156: 459–65.

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search