Decision support system facilitates rapid decreases in pressure support and appropriate inspiratory muscle workloads in adults with respiratory failure

A commercially available decision support system (DSS) provides guidance for setting inspiratory pressure support (PS) to maintain work of breathing (WOB/min), breathing frequency (f), and tidal volume (V_T) in proper clinical ranges (VentAssist™). If these values are outside the proper clinical range patients may suffer fatigue, atrophy, hypoventilation, hyperventilation, volutrauma, or V_T deficiency. The purpose of our study was to evaluate the increase of the percentage of breaths in the targeted clinical ranges when the DSS guidance for setting the PS was followed.

The study included 43 intubated adults with respiratory failure in an academic medical intensive care unit. Each of the patients had received ventilatory support for >24h with no weaning trials attempted. Clinicians switched the ventilator to PS then proceeded to utilize the guidance recommended by the DSS for setting PS for 21 patients (intervention group); while the clinicians caring for the remaining 23 patients did not have access to the DSS (control group).

The use of a DSS to set PS level increased the percentage of breaths in the targeted clinical range [28% to 48%, p value<0.0001]. An unexpected result was that while following the DSS 18 of the 21 patients were rapidly weaned to minimal ventilator settings within 46±38min; however, when the DSS was not available weaning to minimal ventilator settings lasted 21±12h [p value<0.0001].

The DSS is successful at assisting clinicians on how to set PS specific to a patient's individual demands (V_T and f) while accounting for their breathing effort (WOB/min). The DSS appears to promote rapid weaning of PS to minimal ventilator settings when appropriate.