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Ventilation management is crucial in the treatment of Post cardiac surgery patients. Although ventilation therapy is appropriate and improves survival, prolong use and irrationality set parameters are increase the risk of respiratory dysfunction and mortality. Anesthesia recovery and after cardiac surgery, increased of basal metabolic rate and produce of carbon dioxide, patients needed dynamically ventilation support. We aimed to evaluate the safety and efficacy of IntelliVent-ASV mode in ICU patients with post cardiac surgery. To estimate underlying reduce incidence of respiratory dysfunction.
Consecutive patients undergoing cardiac surgery from April to October in 2014 were randomly divided into adaptive support ventilation (ASV) group and IntelliVent-ASV group. Demographic and clinical data were collected on all adult patients with cardiac surgery in ICU. In the ASV group, minute volume (MV), FiO2 and positive end-expiratory pressure (PEEP) were set according to the local hospital protocol based on currently available guidelines. In the IntelliVent-ASV group, clinician set targets for SpO2 and PetCO2 individually, at the same time patient height, sex, ideal body weight, initial FiO2, PEEP, MV were input. According to the physiologic inputs from the patients, IntelliVent-ASV automatically sets ventilator controls to reach targets. FiO2, PEEP, MV, SpO2, PetCO2, Tidal volume (Vt), respiratory rate (RR) and static lung compliance inspiratory pressure were continuously monitored and recorded in time of arrive at ICU(T0),1 hour (T1),2 hour (T2) and before Spontaneous Breathing Trial(TSBT). Vital parameters of signs hemodynamics and blood gas analysis (ABG) were recorded in simultaneously.
Intellivent-ASV group required significantly less FiO2 in T1 (34.00±7.34 Vs. 41.28±5.22,p<0.01), T2 (31.93±4.44 Vs.41.28±4.09,p<0.01), TSBT (31.44±3.13 Vs.39.49±2.24, p<0.01)respectively. VT/PBW were significantly higher in Intellivent-ASV patients, T1 (8.05±1.00 ml/kg Vs. 7.55±1.05 ml/kg, p<0.05), T2 (8.17±1.01 ml/kg to 7.67±0.97 ml/kg, p<0.05), TSBT (9.35±1.40 ml/kg Vs. 7.92±1.31 ml/kg,p<0.01). Matched-pair analysis of PaCO2 in two groups was performed significant differences in T1 (37.67±3.88mmHg to 34.9 0±5.72mmHg, p<0.05). No significant differences in PaO2, pH, lactic, PaO2/FiO2 were monitored. The linear regression shows the positive correlation between PetCO2 and PaCO2(R2=0.607,n=172)in Intellivent-ASV group.
IntelliVent-ASV mode and ASV mode were safe in hemodynamically stable patients following cardiac surgery. PetCO2 as one of the available parameter to set Ventilatior.IntelliVent-ASV can continuously and timely auto adjust parameters to improves an effective support for post cardiac surgery patients.