Related Experiment Videos
A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using
Louise Rose1, Jeffrey J Presneill, Linda Johnston
1The University of Melbourne and Intensive Care Unit, The Royal Melbourne Hospital, Victoria, Australia. louise.rose@utoronto.ca
Objective:
Preliminary assessment of an automated weaning system (SmartCare/PS) compared to usual management of weaning from mechanical ventilation performed in the absence of formal protocols.
Design And Setting:
A randomised, controlled pilot study in one Australian intensive care unit.
Patients:
A total of 102 patients were equally divided between SmartCare/PS and Control.
Interventions:
The automated system titrated pressure support, conducted a spontaneous breathing trial and provided notification of success ("separation potential").
Measurements And Results:
The median time from the first identified point of suitability for weaning commencement to the state of "separation potential" using SmartCare/PS was 20 h (interquartile range, IQR, 2-40) compared to 8 h (IQR 2-43) with Control (log-rank P = 0.3). The median time to successful extubation was 43 h (IQR 6-169) using SmartCare/PS and 40 (14-87) with Control (log-rank P = 0.6). Unadjusted, the estimated probability of reaching "separation potential" was 21% lower (95% CI, 48% lower to 20% greater) with SmartCare/PS compared to Control. Adjusted for other covariates (age, gender, APACHE II, SOFAmax, neuromuscular blockade, corticosteroids, coma and elevated blood glucose), these estimates were 31% lower (95% CI, 56% lower to 9% greater) with SmartCare/PS. The study groups showed comparable rates of reintubation, non-invasive ventilation post-extubation, tracheostomy, sedation, neuromuscular blockade and use of corticosteroids.
Conclusions:
Substantial reductions in weaning duration previously demonstrated were not confirmed when the SmartCare/PS system was compared to weaning managed by experienced critical care specialty nurses, using a 1:1 nurse-to-patient ratio. The effect of SmartCare/PS may be influenced by the local clinical organisational context.
Descriptor:
28. Mechanical ventilation: weaning.
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