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ORIGINAL ARTICLE   Free accessfree

Minerva Anestesiologica 2019 August;85(8):862-70

DOI: 10.23736/S0375-9393.19.12618-1


lingua: Inglese

Proportional assist ventilation feasibility in the early stage of respiratory failure: a prospective randomized multicenter trial

Marcos DELGADO 1 , Carles SUBIRÁ 2, 3, Cecilia HERMOSA 4, Federico GORDO 4, Jordi RIERA 5, Rafael FERNÁNDEZ 2, 3

1 Department of Anesthesiology, Intensive Care Unit, Bürgerspital Solothurn, Solothurn, Switzerland; 2 Intensive Care Unit, Hospital Sant Joan de Deu, Althaia Xarxa Assistencial, Manresa, Spain; 3 CIBERES, International University of Catalunya, Barcelona, Spain; 4 Intensive Care Unit, University Hospital of Henares, Coslada, Spain; 5 Intensive Care Unit, Hospital of Vall d’Hebron, Barcelona, Spain

BACKGROUND: Proportional assist ventilation (PAV+) is an assisted ventilator mode usually applied during weaning. We aimed to determine the feasibility of using PAV+ in the early phase of acute respiratory failure compared to volume-assist control ventilation (V-ACV) in order to shorten the length of mechanical ventilation (MV).
METHODS: We conducted a prospective randomized trial comparing high-assistance PAV+ (gain 80%) vs. V-ACV in four university hospital Intensive Care Units. Patients were included based on a previous pilot trial. Length of MV was the main objective. Secondary objectives were length of stay (LOS) in ICU/hospital, and ICU/hospital/60-day mortality. Statistics: Mann-Whitney U Test and Fisher’s Exact Test.
RESULTS: We could not find differences in length of MV or any of the analyzed variables between the 52 patients with PAV+ and 50 patients with V-ACV. The high PAV+ failure rate (42%) was attributed to excessive sedation, high respiratory rate, and high respiratory effort.
CONCLUSIONS: The use of high-assistance PAV+ in the early phase of MV does not present benefits compared to V-ACV. The high rate of PAV+ failure reinforces the need for sedative optimization, learning curve, and better patient selection.

KEY WORDS: Respiration, artificial; Interactive ventilatory support; Respiratory distress syndrome, adult

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