scholarly journals Randomized Controlled Trial Comparing Adaptive-support Ventilation with Pressure-regulated Volume-controlled Ventilation with Automode in Weaning Patients after Cardiac Surgery

2008 ◽  
Vol 109 (1) ◽  
pp. 81-87 ◽  
Author(s):  
Pascale C. Gruber ◽  
Charles D. Gomersall ◽  
Patricia Leung ◽  
Gavin M. Joynt ◽  
Siu Keung Ng ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Controlled Trial ◽  
Arterial Blood Gas ◽  
Adaptive Support Ventilation ◽  
Controlled Ventilation ◽  
Randomized Controlled ◽  
Arterial Blood ◽  
Volume Controlled Ventilation ◽  
Adaptive Support ◽  
Volume Controlled

Background Adaptive-support ventilation (ASV) is a minute ventilation-controlled mode governed by a closed-loop algorithm. With ASV, tidal volume and respiratory rate are automatically adjusted to minimize work of breathing. Studies indicate that ventilation in ASV enables more rapid weaning. The authors conducted a randomized controlled trial to determine whether ventilation in ASV results in a shorter time to extubation than pressure-regulated volume-controlled ventilation with automode (PRVCa) after cardiac surgery. Methods Fifty patients were randomly assigned to ASV or PRVCa after elective coronary artery bypass grafting. Respiratory weaning progressed through three phases: phase 1 (controlled ventilation), phase 2 (assisted ventilation), and phase 3 (T-piece trial), followed by extubation. The primary outcome was duration of intubation (sum of phases 1-3). Secondary outcomes were duration of mechanical ventilation (sum of phases 1 and 2), number of arterial blood gas samples, and manual ventilator setting changes made before extubation. Results Forty-eight patients completed the study. The median duration of intubation was significantly shorter in the ASV group than in the PRVCa group (300 [205-365] vs. 540 [462-580] min; P < 0.05). This difference was due to a reduction in the duration of mechanical ventilation (165 [120-195] vs. 480 [360-510] min; P < 0.05). There were no significant differences between the ASV and PRVCa groups in the number of arterial blood gas samples taken or manual ventilator setting changes made. Conclusions ASV is associated with earlier extubation, without an increase in clinician intervention, when compared with PRVCa in patients undergoing uncomplicated cardiac surgery.

scholarly journals I-gel supraglottic airway use is efficient and safe during minimal flow anesthesia with volume controlled ventilation - a randomized controlled trial

2020 ◽  
Vol 24 (1) ◽  
pp. 36-41
Author(s):  
Asma Khan ◽  
Mukul Chandra Kapoor ◽  
Shaloo Garg ◽  
Archana Puri ◽  
Ashish Sinha
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Supraglottic Airway ◽  
Minimal Flow ◽  
Controlled Ventilation ◽  
Randomized Controlled ◽  
Volume Controlled Ventilation ◽  
Gas Leak ◽  
Supraglottic Airway Devices ◽  
Volume Controlled

Background: A fear of potential gas leak limits the wide spread use of minimal flow anesthesia with supraglottic airway devices. Second generation supraglottic airway devices have been claimed to be come with good airway seal. I-gel is one of these and it has been extensively evaluated for spontaneous as well as assisted ventilation. We conducted this study to evaluate its use with low flow anesthesia and volume controlled ventilation. Methodology: In a prospective randomized controlled trial, 50 patients undergoing laparoscopic surgeries for less than 2 h duration were administered general anesthesia, with controlled ventilation, using either endotracheal tube or an I-gel for airway control. The total fresh gas flow was gradually reduced until it was 400 mL/min. Patients were monitored for evidence of loss of respiratory gas volume in the breathing circuit and other parameters for ventilation failure. Results: Ventilation could be maintained at a fresh gas flow of 400 mL/min, without clinical or volumetric evidence of gas leak in all patients in the two groups. Two patients in the I-gel group had intraoperative gas leak leading to ventilator failure alarm but the same was corrected by repositioning of the head. The vital signs, peak airway pressure, end-tidal carbon dioxide, set tidal volume and expired tidal volumes were statistically similar in the two groups. Conclusion: I-gel supraglottic airway can be safely and efficiently used for laparoscopic surgery using minimal flow anesthesia and volume controlled ventilation. Citation: Khan A, Kapoor MC, Garg S, Puri A, Sinha A. I-gel supraglottic airway use is efficient and safe during minimal flow anesthesia with volume controlled ventilation - a randomized controlled trial. Anaesth pain intensive care 2020;24(1):__ Abbreviations: Supraglottic airway device – SAD; Volume controlled ventilation – VCV; Pressure controlled ventilation – PCV; Endotracheal tube – ETT; Laryngeal Mask Airway - LMA   DOI: https://doi.org/10.35975/apic.v24i1. Received – 11 June 2019; Reviewed – 20, 23 October 2019; Revised – 31 January 2020; Second Review – 2, 7 January 2020; Accepted – 02 February 2020;

scholarly journals AutoFlow® versus volume-controlled ventilation for laparoscopic gynecological surgery using LMA® ProSeal™: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Toshiyuki Nakanishi ◽  
Seishi Sakamoto ◽  
Manabu Yoshimura ◽  
Takashi Toriumi
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Vital Signs ◽  
Adult Women ◽  
Gynecological Surgery ◽  
Trendelenburg Position ◽  
Controlled Ventilation ◽  
Randomized Controlled ◽  
Volume Controlled Ventilation ◽  
Volume Controlled

Abstract Background During laparoscopic gynecological surgery, increased peak airway pressure (PAWP) can cause airway leak upon ventilation with the LMA® ProSeal™. We hypothesized that compared with the use of volume-controlled ventilation (VCV), the use of the AutoFlow® mode would decrease PAWP and airway leak during laparoscopic gynecological surgery with LMA ProSeal. Methods This single-center, randomized, controlled trial allocated 80 adult women undergoing elective laparoscopic gynecological surgery to one of two groups, namely, the AutoFlow group or the VCV group. Ventilation settings for both groups were 8 ml/kg of tidal volume and 5 cmH2O of positive end-expiratory pressure, and respiratory rate was adjusted to maintain end-tidal carbon dioxide at 35–40 mmHg. Airway leak, PAWP, and other ventilatory parameters and vital signs were recorded at four timepoints (1, 1 min after insertion of the gastric tube; 2, 2 min after intravenous administration of rocuronium 0.6–0.8 mg/kg; 3, 1 min after initiation of pneumoperitoneum; and 4, 1 min after changing to the Trendelenburg position). The primary outcome was PAWP during pneumoperitoneum and in the Trendelenburg position, whereas the secondary outcomes included PAWP at other timepoints and airway leak development. We used the Mann–Whitney U test for PAWP and Fisher’s exact test for comparing airway leak among the groups. Results Data from 40 patients in the AutoFlow group and 39 in the VCV group were used for analysis. PAWP at pneumoperitoneum pressure and in the Trendelenburg position was significantly lower in the AutoFlow group than in the VCV group [median (interquartile range), 16 (15–18) cmH2O vs. 18 (17–19) cmH2O; P < 0.001]. Similarly, patients in the AutoFlow group showed lower PAWP at the other three timepoints measured. Airway leak occurred in four patients in the AutoFlow group and in two patients in the VCV group; however, this incidence was not significantly different (P = 0.68). Conclusions Even though AutoFlow ventilation decreased PAWP, it did not reduce the incidence of airway leak compared with VCV during laparoscopic gynecological surgery with the LMA ProSeal. Trial registration UMIN Clinical Trials Registry, identifier UMIN000023173.

scholarly journals Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial

2020 ◽  
Vol 15 ◽  
Author(s):  
Wagner Souza Leite ◽  
Alita Novaes ◽  
Monique Bandeira ◽  
Emanuelle Olympia Ribeiro ◽  
Alice Miranda Dos Santos ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Randomised Trial ◽  
Good Reliability ◽  
Inspection Method ◽  
Controlled Ventilation ◽  
Volume Controlled Ventilation ◽  
High Incidence ◽  
Ventilation Modes ◽  
Volume Controlled ◽  
Spontaneous Breath

Introduction and aim: Studies regarding asynchrony in patients in the cardiac postoperative period are still only a few. The main objective of our study was to compare asynchronies incidence and its index (AI) in 3 different modes of ventilation (volume-controlled ventilation [VCV], pressure-controlled ventilation [PCV] and pressure-support ventilation [PSV]) after ICU admission for postoperative care. Methods: A prospective parallel randomised trial in the setting of a non-profitable hospital in Brazil. The participants were patients scheduled for cardiac surgery. Patients were randomly allocated to VCV or PCV modes of ventilation and later both groups were transitioned to PSV mode. Results: All data were recorded for 5 minutes in each of the three different phases: T1) in assisted breath, T2) initial spontaneous breath and T3) final spontaneous breath, a marking point prior to extubation. Asynchronies were detected and counted by visual inspection method by two independent investigators. Reliability, inter-rater agreement of asynchronies, asynchronies incidence, total and specific asynchrony indexes (AIt and AIspecific) and odds of AI ≥10% weighted by total asynchrony were analysed. A total of 17 patients randomly allocated to the VCV (n= 9) or PCV (n=8) group completed the study. High inter-rated agreement for AIt (ICC 0.978; IC95%, 0,963-0.987) and good reliability (r=0.945; p<0.001) were found. Eighty-two % of patients presented asynchronies, although only 7% of their total breathing cycles were asynchronous. Early cycling and double triggering had the highest rates of asynchrony with no difference between groups. The highest odds of AI ≥10% were observed in VCV regardless the phase: OR 2.79 (1.36-5.73) in T1 vs T2, p=0.005; OR 2.61 (1.27-5.37) in T1 vs T3, p=0.009 and OR 4.99 (2.37-10.37) in T2 vs T3, p<0.001. Conclusions: There was a high incidence of breathing asynchrony in postoperative cardiac patients, especially when initially ventilated in VCV. VCV group had a higher chance of AI ≥10% and this chance remained high in the following PSV phases.

Sign in / Sign up

Export Citation Format

Share Document