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
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.
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