Research database "Automatic Discontinuation of Mechanical Ventilation in Obese Patients After Cardiac Surgery: A Retrospective Analysis."

Introduction: There is a big progress in providing respiratory support in recent years with increasing safety and decreasing duration. However, there are still many unanswered questions, particularly about successful weaning from invasive ventilation. We consider to use an intellectual ventilation mode to optimize weaning from invasive ventilation.
Objectives: The main goal of this retrospective analysis was to assess the possibility of based on Adaptive Support Ventilation mode to select appropriate ventilatory parameters for effectively discontinuing ventilatory parameters in patients with obesity after cardiac surgery. Additionally, we hypothesize that this approach can optimize diaphragmatic function in early restoration of diaphragmatic activity and decreasing the workload.
Material and Methods: We compare the discontinuation processes in our previous trials. It was two trials about using INTELLiVENT – ASV® mode and conventional ventilation modes (SIMV – switching to PSV after restoration of own respiratory activity). In the first part we assess 80 patients with BMI > 30 kg/m2, 40 of them were ventilated in INTELLiVENT – ASV®, and 40 in SIMV – PSV modes. In the second part we considered 32 patients with BMI > 35 kg/m2; 16 of them were ventilated in INTELLiVENT – ASV®, and 16 in SIMV – PSV modes.
Results: The duration of spontaneous ventilation (without any mandatory breaths) was longer in the groups that used the automatic INTELLiVENT – ASV® mode. The pressure support (PS) and P0.1 level was lower in these groups. The tidal volume and PEEP levels were higher in the groups using conventional modes. Also, in the INTELLiVENT-ASV groups, the number of manual ventilator settings and the time physicians spent near the ventilator before tracheal extubation were significantly lower.
Conclusion: The using of intellectual modes in weaning of respiratory support process safe for cardiac surgery patients with obesity (including in patients with BMI > 35kg/m2). This reduces the duration of mandatory breathing periods, decreases tidal volume, pressure support, and PEEP levels, without compromising arterial oxygenation. Moreover, it helps to reduce the time that physicians spend near the respirator.