SESSION TITLE: Ventilatory Strategies in Severe Hypoxemia
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 30, 2013 at 07:30 AM - 09:00 AM
PURPOSE: Thirty percent of ICU patients experience difficult or prolonged weaning from mechanical ventilation (MV). Use of weaning protocols incorporating spontaneous breathing trials (SBT) and nonfatiguing modes such as pressure support ventilation (PSV) are recommended in these cases. Proportional assist ventilation (PAV) provides assistance in proportion to patient effort, which may optimize weaning. The purpose of this pilot study was to assess safety and feasibility for a future randomized controlled trial (RCT) designed to detect differences in time to extubation between weaning protocols utilizing PSV plus SBT vs. PAV plus SBT.
METHODS: Adult patients intubated >36 hours were randomized in the study if they met eligibility criteria for weaning, tolerated PSV ≥30 minutes, and either failed or did not meet criteria for an SBT. Patients were randomized to either the PSV or PAV weaning algorithm (PAV+™, Puritan Bennett 840, Covidien, Boulder, USA). Both algorithms utilized progressive decreases in level of assistance as tolerated, coupled with daily assessment for SBTs.
RESULTS: Of 54 patients randomized, outcome data is available for 50 patients; 27 were randomized to receive PAV and 23 to receive PSV. Patients were well matched at baseline with respect to age (62.5±6 vs. 62.7±18), APACHE II score at time of randomization (21±4 vs. 22±4) and median (IQR) days on ventilator prior to randomization: 6.3(4.1-7.9) vs. 5.2(3.9-10.2) on PAV vs. PSV respectively. The time from randomization to successful extubation was 4.0(2.8-8.4) days on PAV vs. 4.9(3.0-18.3), p=NS with separation of the Kaplan Meier curves after 7 days. Time from randomization to live ICU discharge was 7.1(5.2-11.4) days on PAV vs. 10.5(7.4-24.5) days on PSV, p=0.03. There were no adverse events linked to the study interventions and protocol violations were infrequent. Recruitment was slower than projected (1.3 patients/month).
CONCLUSIONS: This pilot study confirmed acceptability and safety of the weaning algorithms.
CLINICAL IMPLICATIONS: This pilot study provides rationale and important information to guide the design of a future RCT comparing weaning from MV on PSV vs. PAV.
DISCLOSURE: Karen Bosma: Grant monies (from industry related sources): Received grant money from Covidien for this study The following authors have nothing to disclose: Brooke Read, Mohammad Nikoo, Tracey Bentall, Chris Harris, Phillip Jones, Fran Priestap, Ronald VanderHeide
No Product/Research Disclosure Information