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Weaning children from mechanical ventilation with a computer-driven protocol: a pilot trial

Philippe A Jouvet1, Valérie Payen, France Gauvin

  • 1Pediatric ICU, Soins Intensifs Pédiatriques, Hôpital Sainte Justine, Montreal, QC, Canada. philippe.jouvet@umontreal.ca

Intensive Care Medicine
|January 31, 2013
PubMed

Insights

A computer-driven protocol significantly reduced mechanical ventilation weaning time in children aged 2-17 years. This study demonstrates the feasibility of a pediatric randomized trial for computerized weaning protocols.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory therapy
  • Clinical trial methodology

Background:

  • Written protocols have reduced mechanical ventilation weaning duration in adults, but not significantly in children.
  • Assessing the impact of computerized protocols on pediatric mechanical ventilation weaning is crucial.

Purpose of the Study:

  • To evaluate the feasibility of a multicenter randomized clinical trial comparing computerized protocol-driven weaning to usual care in pediatric patients.
  • To determine if a computer-driven protocol can decrease the duration of mechanical ventilation weaning in children.

Main Methods:

  • A single-center randomized trial included 30 mechanically ventilated children (2-17 years) on pressure support, not receiving inotropes.
  • Participants were randomized to either usual care (n=15) or a computer-driven protocol (Smartcare/PS™, n=15).
  • The primary outcome was the duration of weaning until first extubation, analyzed using a Mann-Whitney U test.

Main Results:

  • The median weaning duration was significantly shorter in the computer-driven protocol group (21 hours) compared to the usual care group (90 hours) (p=0.007).
  • Reintubation rates within 48 hours and noninvasive ventilation use after extubation were similar between groups.

Conclusions:

  • A pediatric randomized trial using a computerized weaning protocol in North America is feasible.
  • Expanding the computer-driven protocol to include children younger than 2 years could further enhance its utility and reduce screened admissions in multicenter trials.
Abstract

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