Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Respirology. 2013 Oct;18(7):1108-15. doi: 10.1111/resp.12126.
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.
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.
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.
There was no significant difference in the outcomes of patients with ARDS ventilated with either VCV or ASV in this study.
小潮气量通气已被证明可改善急性呼吸窘迫综合征（ARDS）患者的生存率。适应性支持通气（ASV）作为一种闭环通气模式，可最大限度地降低呼吸功，从而有可能改善 ARDS 患者的预后。本试验旨在比较 ARDS 患者使用 ASV 与容量控制通气（VCV）的结局。
将 ARDS 患者随机分配至 ASV 或 VCV 组。主要结局为机械通气时间、新发器官功能障碍和住院时间。次要结局为呼吸机模式使用的难易程度（使用视觉模拟评分（VAS）评估）、每日血气分析次数、每日镇静和神经肌肉阻滞剂的需求以及死亡率。
在研究期间，48 例 ARDS 患者（男 28 例，女 20 例）被随机分为接受 ASV（n=23）或 VCV（n=25）治疗。两组的基线特征几乎相似。两组的机械通气时间、序贯器官衰竭评估（SOFA）评分差值、重症监护病房（ICU）和住院时间均无显著差异。两组的死亡率（VCV-36% vs ASV-34.7%）、机械通气的易用性、每日咪达唑仑和维库溴铵剂量以及进行的血气分析次数也相似。
在本研究中，接受 VCV 或 ASV 通气的 ARDS 患者的结局无显著差异。
