Patient-ventilator interaction with conventional and automated management of pressure support during difficult weaning from mechanical ventilation
Por:
Grieco, DL, Bitondo, MM, Aguirre-Bermeo, H, Italiano, S, Idone, FA, Moccaldo, A, Santantonio, MT, Eleuteri, D, Antonelli, M, Mancebo, J, Maggiore, SM
Publicada:
1 dic 2018
Resumen:
Purpose: Optimizing pressure support ventilation (PSV) can improve patient-ventilator interaction. We conducted a two-center, randomized cross-over study to determine whether automated PSV lowers asynchrony rate during difficult weaning from mechanical ventilation.
Methods: Thirty patients failing the first weaning attempt were randomly ventilated for 2 three-hour consecutive periods with: 1)PSV managed by physicians (convPSV); 2)PSV managed by Smartcare (R) (autoPSV). These 2 periods were applied in the afternoon and overnight, for a 12-h total study time. Two independent clinicians online analyzed ventilator waveforms to compute asynchrony index(AI).
Results: AI was lower during autoPSV than during convPSV (medians[interquartile ranges] 5.1(2.6-9.51% vs. 7.3(2.3-13.41%. p = 0.02), without changes in the proportion of patients with AI>10%(p = 0.31). Pressure support (PS) variability was higher during autoPSV (p < 0.001), but average PS did not vary. In patients with baseline PS > 12 cmH(2)O (n = 15), PS and tidal volume were lower with autoPSV (12 [10-15]cmH(2)O vs. 15 [14-18]cmH(2)O,p = 0.003; 7.2[6.2-8.3]ml/Kg vs. 8.2[7.1-9.1]ml/kg. p = 0.02) and AI reduction was driven by lower tidal volume (p = 0.03). In patients with baseline PS <= 12 cmH(2)O, AI reduction during autoPSV was mediated by increased PS var- iability (p = 0.04).
Conclusion: During difficult weaning, autoPSV improves patient-ventilator interaction by lowering tidal volume and enhancing PS variability. In expert centres, however, the size effect of the intervention appears clinically small, likely because physicians themselves adequately limit PS and tidal volume. (C) 2018 Elsevier Inc. All rights reserved.
Filiaciones:
Grieco, DL:
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care, Largo Agostino Gemelli 8, I-00168 Rome, Italy
Bitondo, MM:
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care, Largo Agostino Gemelli 8, I-00168 Rome, Italy
Aguirre-Bermeo, H:
St Pau Univ Hosp, Dept Intens Care, Carrer St Quinti 89, Barcelona 08041, Spain
Italiano, S:
St Pau Univ Hosp, Dept Intens Care, Carrer St Quinti 89, Barcelona 08041, Spain
Idone, FA:
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care, Largo Agostino Gemelli 8, I-00168 Rome, Italy
Moccaldo, A:
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care, Largo Agostino Gemelli 8, I-00168 Rome, Italy
Santantonio, MT:
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care, Largo Agostino Gemelli 8, I-00168 Rome, Italy
Eleuteri, D:
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care, Largo Agostino Gemelli 8, I-00168 Rome, Italy
Antonelli, M:
Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care, Largo Agostino Gemelli 8, I-00168 Rome, Italy
Mancebo, J:
St Pau Univ Hosp, Dept Intens Care, Carrer St Quinti 89, Barcelona 08041, Spain
Maggiore, SM:
Gabriele dAnnunzio Univ Chieti Pescara, Dept Med Oral & Biotechnol Sci, Sect Anesthesia Analgesia Perioperat & Intens Car, SS Annunziata Hosp,Sch Med & Hlth Sci, Via Vestini, I-66100 Chieti, Italy
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