Pressure support ventilation advisory system provides valid recommendations for setting ventilator.

Area of Science:

• Mechanical Ventilation
• Respiratory Physiology
• Clinical Decision Support Systems

Background:

• Optimizing pressure support ventilation (PSV) is crucial for appropriate inspiratory muscle unloading.
• A novel computerized advisory system was developed using a fuzzy-logic algorithm.
• This system assesses inspiratory muscle load and breathing tolerance to guide PSV settings.

Purpose of the Study:

• To validate a computerized advisory system for setting pressure support ventilation (PSV).
• To compare the system's PSV recommendations with those of experienced critical-care Registered Respiratory Therapists (RRTs).

Main Methods:

• A clinical validation study involved 76 adult patients with respiratory failure receiving PSV.
• A combined pressure/flow sensor provided noninvasive measurements of work of breathing, breathing frequency, and tidal volume.
• The advisory system's recommendations were compared against RRTs' bedside recommendations.

Main Results:

• No significant differences were found between the advisory system's and RRTs' recommendations for adjusting PSV.
• The advisory system's recommendations were agreed upon by RRTs in 91% of cases (kappa = 0.85).
• The system accurately predicted RRTs' PSV recommendations (r² = 0.87).

Conclusions:

• A load and tolerance strategy using a computerized PSV advisory system offers valid recommendations for inspiratory muscle unloading.
• The system's recommendations closely matched those of experienced critical-care RRTs.
• The automated, continuous operation of the PSV advisory system may benefit clinical settings lacking constant expert availability.