Hybrid mechanical ventilation with BIPAP and ATC in acute respiratory failure

7. SUMMARYHybrid Mechanical Ventilation with BIPAP and ATC inAcute Respiratory FailureThe aim of the study: This study aimed to determine the effects of different durations ofBIPAP on haemodynamics, mechanical ventilation parameters and alveolar gas exchange overBIPAP and ATC ventilation in patients with acute respiratory failure.Materials and methods: We studied 60 adult patients with acute respiratory failure. Aftersedation with remifentanil-midazolam (Ramsay sedation scale was 3), patients were ventilatedwith Dräger Evita 4 ventilator. After initial stabilazation with BIPAP ventilation for one hour,patients were randomized to two groups. After BIPAP ventilation [for group 1 (n=30) 6 hours;for group 2 (n=30) 12 hours] 100% ATC was applied for 6 hours. Ventilator parameters wereadjusted as; Pinsp <30 cmH O, fmec ≤16/min, I: E ratio 1:2, FiO < 0.6, PEEP = 5 cmH O, VT ≤2 2 28 mL/kg. The PaCO and PaO levels were maintained between 35-50 mmHg and 70-1102 2mmHg, respectively. All data were recorded at three points; T1: one hour after the initiation ofmechanical ventilation, T2: at the end of the BIPAP ventilation, T3: at the end of BIPAP + ATCventilation.Results: The results showed that there was no statistically difference in demographic andclinical conditions of the patients, haemodynamic data, PEEP , airway compliance, PaCO SaOi 2, 2ve PaO values between two groups. Adding more earlier ATC on BIPAP ventilation resulted in2P VT , VT , FiO values were reduced (p<0.05). MV values and horovitz index wereinsp, insp eksp 2 spo/topincreased (p<0.05). The ratio of spontaneous breathing to total minute ventilation were increasedat the two groups (for group 1, p<0.05)Discussion and conclusions: In adult patients with acute respiratory failure, we foundthat; the earlier ATC adding on BIPAP reduced inspiratory airway pressures, tidal volumes andFiO levels, effectively. It also increased MV values and horovitz index effectively.2 spo/topAdditionally, we think the clinical advantages should be proven for homogenous sub groups andlong term ventilation.Key words: Acute respiratory failure, BIPAP, ATC, hybrid ventilation.