Clinical evaluation of a computer-controlled pressure support mode.

We have designed a computerized system providing closed-loop control of the level of pressure support ventilation (PSV). The system sets itself at the lowest level of PSV that maintains respiratory rate (RR), tidal volume (VT), and end-tidal CO(2) pressure (PET(CO(2))) within predetermined ranges defining acceptable ventilation (i.e., 12 < RR < 28 cycles/min, VT > 300 ml [> 250 if weight < 55 kg], and PET(CO(2)) < 55 mm Hg [< 65 mm Hg if chronic CO(2) retention]). Ten patients received computer-controlled (automatic) PSV and physician-controlled (standard) PSV, in random order, during 24 h for each mode. An estimation of occlusion pressure (P(0.1)) was recorded continuously. The average time spent with acceptable ventilation as previously defined was 66 +/- 24% of the total ventilation time with standard PSV versus 93 +/- 8% with automatic PSV (p < 0.05), whereas the level of PSV was similar during the two periods (17 +/- 4 cm H(2)O versus 19 +/- 6 cm H(2)O). The time spent with an estimated P(0.1) above 4 cm H(2)O was 34 +/- 35% of the standard PSV time versus only 11 +/- 17% of the automatic PSV time (p < 0.01). Automatic PSV increased the time spent within desired ventilation parameter ranges and apparently reduced periods of excessive workload.

[1]  Silvia Miksch,et al.  Utilizing temporal data abstraction for data validation and therapy planning for artificially ventilated newborn infants , 1996, Artif. Intell. Medicine.

[2]  W. Whitelaw,et al.  Occlusion pressure as a measure of respiratory center output in conscious man. , 1975, Respiration physiology.

[3]  W. Heinrichs,et al.  An adaptive lung ventilation controller , 1994, IEEE Transactions on Biomedical Engineering.

[4]  Laurent Brochard,et al.  Pressure support ventilation , 1991 .

[5]  M. Tobin,et al.  Pattern of recovery from diaphragmatic fatigue over 24 hours. , 1995, Journal of applied physiology.

[6]  G. Iotti,et al.  Closed-loop control of airway occlusion pressure at 0.1 second (P0.1) applied to pressure-support ventilation: algorithm and application in intubated patients. , 1996, Critical care medicine.

[7]  F Lemaire,et al.  Improved efficacy of spontaneous breathing with inspiratory pressure support. , 1987, The American review of respiratory disease.

[8]  François Pachet,et al.  NéoGanesh: a working system for the automated control of assisted ventilation in ICUs , 1997, Artif. Intell. Medicine.

[9]  L. Brochard,et al.  Estimation of occlusion pressure during assisted ventilation in patients with intrinsic PEEP. , 1996, American journal of respiratory and critical care medicine.

[10]  J. L. Gall,et al.  A simplified acute physiology score for ICU patients , 1984, Critical care medicine.

[11]  D. Pierson,et al.  Prediction of successful ventilator weaning using airway occlusion pressure and hypercapnic challenge. , 1987, Chest.

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

[13]  C. K. Mahutte,et al.  Airway occlusion pressure. An important indicator for successful weaning in patients with chronic obstructive pulmonary disease. , 1987, The American review of respiratory disease.

[14]  C. K. Mahutte,et al.  Work of breathing and airway occlusion pressure during assist-mode mechanical ventilation. , 1988, Chest.

[15]  M. Tobin.  Principles and Practice of Mechanical Ventilation , 1994 .

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

[17]  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.

[18]  W. Sanborn.  Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. , 1989, The American review of respiratory disease.

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

[20]  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.

[21]  M. Chambrin,et al.  AutoRegulated Inspiratory Support ventilation , 1992, 1992 14th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[22]  S. Allen,et al.  The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation. , 2015, The American review of respiratory disease.

[23]  M. Antonelli,et al.  Early prediction of successful weaning during pressure support ventilation in chronic obstructive pulmonary disease patients , 1992, Critical care medicine.

[24]  N. MacIntyre,et al.  Respiratory function during pressure support ventilation. , 1986, Chest.

[25]  Jan Eric Larsson,et al.  Evaluation of a medical diagnosis system using simulator test scenarios , 1997, Artif. Intell. Medicine.