Adaptive Support Ventilation Versus Synchronized Intermittent Mandatory Ventilation With Pressure Support in Weaning Patients After Orthotopic Liver Transplantation
Celli P, Privatoa E, et alTransplantation Proceedings 2014; 46: 2272-2278.
Aims
To compare the adaptive support ventilation (ASV) with synchronized intermittent mandatory ventilation with pressure support (P-SIMV), in patients after orthotopic liver transplantation (OLT).
Interventions
Patients were randomized to a four phase weaning protocol of the ASV treatment or the P-SIMV standard treatment.
Participants
Adult patients (>18 years old) who had undergone OLT
Outcomes
Outcomes measured were average duration of phases 1, 2, and 3, total length of extubation, number of manual changes in ventilatory settings, high respiratory pressure episodes, number of patients with high inspiratory pressure episodes, average airway Ppeak (cm H2O) and average arterial blood gas analysis values.
Follow-up
72 hours posttransplant
CET Conclusions
This is a small randomised controlled trial of two methods of ventilatory support in the period leading to extubation after orthotopic liver transplantation. Due to its small size (20 patients) it should only be considered a preliminary study and no power calculation was done. The method of randomisation was not described in paper unfortunately, and it was also unclear how many exclusions there were. The abstract claims that rapid extubation can represent a great benefit for the graft, but this outcome is not assessed by the paper. Unsurprisingly, the less automated process required more modifications to the ventilator settings. Blood gas values including pH, PaCO2 and PO2 did not differ between the two groups however. The total length of intubation time was significantly less in the automated group, by about 80 minutes on average, but exactly what time period this represents is not clearly described.
Data analysis
Per protocol analysis
Trial registration
None