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An open-loop, physiological model based decision support system can reduce pressure support while acting to preserve

Savino Spadaro1, Dan Stieper Karbing2, Francesca Dalla Corte1

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|October 15, 2018
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Summary

A clinical decision support system (CDSS) optimized pressure support (PS) ventilation to reduce respiratory muscle effort and minimize oxygen use. The CDSS successfully lowered fraction of inspired oxygen (FIO2) while maintaining safe oxygen saturation levels.

Keywords:
Clinical decision supportEsophageal pressureMechanical ventilationPhysiological modelsPressure support

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Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology
  • Medical Informatics

Background:

  • Mechanical ventilation is crucial for critically ill patients.
  • Optimizing ventilator settings is essential to prevent complications like respiratory muscle dysfunction and lung injury.
  • Clinical decision support systems (CDSS) offer potential for improving ventilator management.

Purpose of the Study:

  • To evaluate if a CDSS can guide pressure support (PS) and fraction of inspired oxygen (FIO2) settings.
  • To ensure appropriate breathing effort and minimize FIO2 during mechanical ventilation.
  • To assess the impact of CDSS recommendations on respiratory muscle activity and gas exchange.

Main Methods:

  • A prospective, cross-over study was conducted on 15 ICU patients receiving PS ventilation.
  • Ventilator support was manipulated (over- and under-support) by adjusting PS or PEEP.
  • CDSS advice was implemented, and measurements included the tension-time index of inspiratory muscles (TTies) and respiratory variables.

Main Results:

  • Over-support with PS reduced respiratory muscle activity (TTies) but tended to increase tidal volume (VT).
  • CDSS advice led to reduced PS, increased TTies, and a trend towards reduced VT.
  • CDSS advice significantly reduced FIO2 by 12-14%, maintaining SpO2 at safe levels (median 96%).
  • Changes in PEEP did not significantly alter physiological variables or CDSS advice.

Conclusions:

  • The CDSS effectively recommended lower PS settings, supporting respiratory muscle function and preventing over-inflation.
  • CDSS guidance minimized FIO2 while maintaining adequate oxygen saturation.
  • The system's advice on PS settings did not preclude extubation and aimed to preserve respiratory muscle function.