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Research ArticleOriginal Research

Automatic Tube Compensation as an Adjunct for Weaning in Patients With Severe Neuroparalytic Snake Envenomation Requiring Mechanical Ventilation: A Pilot Randomized Study

Ashutosh N Aggarwal, Ritesh Agarwal and Dheeraj Gupta
Respiratory Care December 2009, 54 (12) 1697-1702;
Ashutosh N Aggarwal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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  • For correspondence: [email protected]
Ritesh Agarwal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Dheeraj Gupta
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract

OBJECTIVE: This study aimed to evaluate if the combination of pressure-support ventilation (PSV) and automatic tube compensation (ATC) is superior to PSV alone in weaning patients with severe neurotoxic snake envenoming receiving mechanical ventilation.

METHODS: Forty-one patients on volume controlled continuous mandatory ventilation were randomized to weaning with PSV alone (PSV group, 18 patients) or PSV plus ATC (ATC group, 23 patients). In both groups, PSV was initially set at 15 cm H2O, and CPAP at 5 cm H2O, with progressive downward titration. The ATC group additionally, received inspiratory ATC at 100% through a ventilator-software-driven algorithm. The primary outcome measure was weaning duration. Secondary outcomes studied included reintubation rate, occurrence of pneumonia, and hospital mortality.

RESULTS: Median time to presentation to hospital after snake bite was 7 hours (interquartile range [IQR] 4-9.5 h). Median duration of weaning was significantly shorter in the ATC group than in the PSV group (8 h, 95% confidence interval 6.6-9.4 h vs 12 h, 95% confidence interval 9.9-14.1 h, P = .03 via log-rank test). Median duration of mechanical ventilation and intensive-care-unit stay were similar between the PSV and the ATC groups (36.5 h, IQR 23.0-52.0 h vs 41.0 h, IQR 25.0-48.0 h, and 3.5 d, IQR 2-4 d vs 3 d, IQR 2-4 d, respectively). Three patients in the PSV group and none in the ATC group developed pneumonia (P = .08). No patient in either group needed reintubation or died in hospital.

CONCLUSION: The addition of ATC to a standard PSV-based weaning protocol significantly shortened time needed to wean patients with severe neurotoxic snake envenoming, without changing the duration of medical care, morbidity, or mortality.

  • automatic tube compensation
  • Elapidae
  • pressure-support ventilation
  • snake bites
  • ventilator weaning

Footnotes

  • Correspondence: Ashutosh N Aggarwal MD DM, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012 India. E-mail: ashutosh{at}indiachest.org.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2009 by Daedalus Enterprises Inc.
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Respiratory Care: 54 (12)
Respiratory Care
Vol. 54, Issue 12
1 Dec 2009
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Automatic Tube Compensation as an Adjunct for Weaning in Patients With Severe Neuroparalytic Snake Envenomation Requiring Mechanical Ventilation: A Pilot Randomized Study
Ashutosh N Aggarwal, Ritesh Agarwal, Dheeraj Gupta
Respiratory Care Dec 2009, 54 (12) 1697-1702;

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Automatic Tube Compensation as an Adjunct for Weaning in Patients With Severe Neuroparalytic Snake Envenomation Requiring Mechanical Ventilation: A Pilot Randomized Study
Ashutosh N Aggarwal, Ritesh Agarwal, Dheeraj Gupta
Respiratory Care Dec 2009, 54 (12) 1697-1702;
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Keywords

  • automatic tube compensation
  • Elapidae
  • pressure-support ventilation
  • snake bites
  • ventilator weaning

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