急性呼吸窘迫综合征完整通气支持适应性支持通气:一个试点,随机对照试验

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Adaptive support ventilation (ASV) is a closed-loop ventilation mode for which the ven-tilator adjusts inspiratory pressure to achieve a tidal volume that minimizes the work of breathing.
适应性支持通气(ASV)是调节吸气压力达到一定潮气量,呼吸做功最小化的闭环通气模式

Sixty-one patients undergoing elective fast-track cardiac valvular surgery were randomly assigned to receive and be weaned using ASV or be ventilated and weaned as directed by duty physicians (control group).
61例经历选择性快速心脏瓣膜手术患者， 随机分配两组： ASV通气模式组和实验对照组。
ASV reduced the duration of mechanical ventilation in the intensive care unit by more than 2 h, from a median of 342 min in the control group to 205 min in the ASV group. ASV also reduced the number of manual ventilator setting changes and the number of ventilator alarms.
重症监护室ASV通气模式平均减少患者支持通气2 h以上，ASV组205分钟，对照组342分钟。
ASV通气模式同时减少人工调节呼吸机参数设置次数和呼吸机警报的次数。

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Background and objective
Low tidal volume ventilation has been shown to improve survival in acute respiratory distress syndrome (ARDS). Adaptive support ventilation (ASV), a closed-loop ventilatory mode, can minimize the work of breathing, and thus potentially improve the outcomes in ARDS. The aim of this pilot, randomized clinical trial was to compare the outcomes of ASV versus volume-cycled ventilation (VCV) in ARDS.
低潮气量呼吸支持通气可以改善急性呼吸窘迫综合征(ARDS)的生存。适应性支持通气(ASV),一个闭环通气模式,可以减少呼吸做功,从而可能改善ARDS的预后。本试验的目：随机临床实验比较应用ASV和volume-cycled(VCV)通气模式ARDS病人预后。

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Methods
Patients with ARDS were randomly allocated to either ASV or VCV. The primary outcomes were duration of mechanical ventilation, new-onset organ dysfunction and hospital length of stay. The secondary outcomes were ease of use of the ventilator mode (assessed using the visual analogue scale (VAS)), number of daily arterial blood gas analyses, daily requirements of sedative and neuromuscular blockers, and mortality.
ARDS患者被随机分两组ASV组或VCV组。记录呼吸机支持通气时间,初发器官功能障碍和住院时间。其次记录易于使用的呼吸机模式(评估使用视觉模拟量表),每天的动脉血气分析、镇静神经肌肉阻滞剂,每日所需的蛋白质和死亡率。

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Results
Forty-eight patients (28 males, 20 females) with ARDS were randomized to receive either ASV (n = 23) or VCV (n = 25) during the study period. The baseline characteristics were almost similar in the two groups. The duration of mechanical ventilation, delta sequential organ failure assessment scores, intensive care unit and hospital stay were comparable in the two groups. The mortality (VCV-36% vs ASV-34.7%), ease of use of mechanical ventilation, daily midazolam and vecuronium doses, and the number of arterial blood gas analyses performed were also similar in the two groups.
48例ARDS患者(男性28例,女性20例)，研究期间随机分配接受ASV(n = 23)或VCV(n = 25)。两组基线特征几乎相似。呼吸支持通气时间,delta 器官顺序衰竭评估分数，比较两组重症监护室天数和住院天数，死亡率( VCV - 36%， ASV- 34.7%), 易于使用的呼吸支持模式,每日咪达唑仑剂量和维库剂量,动脉血气分析的结果，两组表现类似。