Computer-driven management of prolonged mechanical ventilation and weaning: a pilot study

ObjectiveTo evaluate the ability of a computer-driven system (CDS) to manage pressure-support ventilation over prolonged periods and to predict weaning readiness compared to intensivists. The system continuously adapts pressure support, gradually decreases ventilatory assistance when possible, and indicates weaning readiness.Design and settingA two-center, prospective, open, clinical, pilot study in medical ICUs of two university hospitals.Patients and participants42 consecutive mechanically ventilated patients (60±14 years, SAPS II 39±15), 9 of whom were excluded.InterventionsAs soon as patients could tolerate pressure support, they were ventilated with the CDS. The times of weaning readiness determined by the intensivists and CDS were compared.Measurements and resultsWeaning was successful in 25 patients and failed in 7; unplanned extubation occurred in 1 patient. Time on CDS ventilation was 3±3 days (maximum, 12 days). The CDS detected weaning readiness earlier than the intensivists in 17 patients, and intensivists earlier than the CDS in 4; in 11 patients detection times coincided.ConclusionsA CDS was successful in fully managing pressure-support ventilation over prolonged periods and often proposed weaning readiness earlier than the intensivists did. Use of this CDS may reduce the duration of mechanical ventilation.

[1]  J. H. Strickland,et al.  A Computer-controlled Ventilator Weaning System: A Clinical Trial , 1993 .

[2]  M Dojat,et al.  Clinical evaluation of a computer-controlled pressure support mode. , 2000, American journal of respiratory and critical care medicine.

[3]  S Sauer,et al.  A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. , 1997, Critical care medicine.

[4]  Ose,et al.  A COMPARISON OF FOUR METHODS OF WEANING PATIENTS FROM MECHANICAL VENTILATION , 1997 .

[5]  R. Rodríguez-Roisín,et al.  Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. , 1995, American journal of respiratory and critical care medicine.

[6]  J. Strickland,et al.  A computer-controlled ventilator weaning system. , 1991, Chest.

[7]  S K Pingleton,et al.  Complications of acute respiratory failure. , 1988, The Medical clinics of North America.

[8]  L. Blanch,et al.  Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. , 1999, American journal of respiratory and critical care medicine.

[9]  Dean F. Sittig,et al.  Implementation of a computerized patient advice system using the HELP clinical information system. , 1989, Computers and biomedical research, an international journal.

[10]  J. Chastre,et al.  Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. , 1989, The American review of respiratory disease.

[11]  M Dojat,et al.  Evaluation of a knowledge-based system providing ventilatory management and decision for extubation. , 1996, American journal of respiratory and critical care medicine.

[12]  E F Haponik,et al.  Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. , 1996, The New England journal of medicine.

[13]  M Dojat,et al.  A knowledge-based system for assisted ventilation of patients in intensive care units , 1992, International journal of clinical monitoring and computing.

[14]  A. Esteban,et al.  A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. , 1995, The New England journal of medicine.

[15]  D A Tong,et al.  Weaning patients from mechanical ventilation. A knowledge-based system approach. , 1990, Computer methods and programs in biomedicine.

[16]  Jeanette X. Polaschek,et al.  The design and implementation of a ventilator-management advisor , 1993, Artif. Intell. Medicine.

[17]  R. Fernandez,et al.  Clinical consequences of the implementation of a weaning protocol , 1996, Intensive Care Medicine.

[18]  S. Epstein,et al.  Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. , 1998, American journal of respiratory and critical care medicine.

[19]  C Frostell,et al.  A knowledge-based support system for mechanical ventilation of the lungs. The KUSIVAR concept and prototype. , 1989, Computer methods and programs in biomedicine.

[20]  F. Gordo,et al.  Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. , 1997, American journal of respiratory and critical care medicine.

[21]  L. Brochard,et al.  Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. , 1994, American journal of respiratory and critical care medicine.

[22]  J B Wong,et al.  Effect of failed extubation on the outcome of mechanical ventilation. , 1997, Chest.