Is proportional-assist ventilation with load-adjustable gain factors a user-friendly mode?

Byline: Nectaria Xirouchaki (1), Eumorfia Kondili (1), Maria Klimathianaki (1), Dimitris Georgopoulos (1) Keywords: Ventilator settings; Sedatives; Analgesics; Vasoactive medications; Critically ill Abstract: Objectives The aim of this study was to compare the number of interventions (ventilator settings and sedatives, analgesics and vasoactive medication dose manipulations) between critically ill patients on proportional-assist ventilation with load-adjustable gain factors (PAV+) and those on pressure support (PS). Design Retrospective analysis of data from a previous randomized clinical trial. Methods A total of 208 patients who were mechanically ventilated on controlled modes and met criteria for assisted breathing were randomized to receive either PS (n = 100) or PAV+ (n = 108). Changes in ventilator settings and in the dose of sedatives, analgesics, and vasoactive medications were identified during the period in which the patients were ventilated either with PS (30.4 +- 17.4 h) or PAV+ (30.0 +- 18.1 h) and classified as changes to facilitate weaning (CFW) or changes to respond to deterioration (CD). Results The mean number of changes in ventilator settings was significantly higher with PS than that with PAV+ (10.7 +- 5.7 vs. 8.9 +- 4.6). With PS the proportion of these changes classified as CFW was significantly lower than that with PAV+ (59.8% vs. 69.2%). Dyssynchrony as a cause of CD was more likely to occur with PS than with PAV+ (42 vs. 3%). The mean number of changes in the dose of sedatives, analgesics, and vasoactive medications was higher with PS than with PAV+, the difference being significant only for sedatives (4.06 +- 3.8 vs. 2.82 +- 3.4). Conclusions Compared to PS, PAV+ is associated with fewer intervention in terms of ventilator settings and sedative dose changes. Author Affiliation: (1) Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece Article History: Registration Date: 28/05/2009 Received Date: 19/03/2009 Accepted Date: 20/05/2009 Online Date: 16/06/2009 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00134-009-1524-2) contains supplementary material, which is available to authorized users.