Intensive Care Medicine

, Volume 39, Issue 5, pp 919–925

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

  • Philippe A. Jouvet
  • Valérie Payen
  • France Gauvin
  • Guillaume Emeriaud
  • Jacques Lacroix
Pediatric Original

DOI: 10.1007/s00134-013-2837-8

Cite this article as:
Jouvet, P.A., Payen, V., Gauvin, F. et al. Intensive Care Med (2013) 39: 919. doi:10.1007/s00134-013-2837-8

Abstract

Purpose

Duration of weaning from mechanical ventilation is decreased with the use of written protocols in adults. In children, the use of written protocols has not had such an impact.

Methods and measurements

We conducted a single-center trial to assess the feasibility of conducting a multicenter randomized clinical trial comparing the duration of weaning from mechanical ventilation in those managed by a computer-driven explicit protocol versus usual care. Mechanically ventilated children aged between 2 and 17 years on pressure support and not receiving inotropes were included. After randomization, children were weaned either by usual care (n = 15) that was characterized by no protocolized decisions by attending physicians, or by a computer-driven protocol (Smartcare/PS™, Drager Medical) (n = 15). Weaning duration until first extubation was the primary outcome. For comparison, a Mann–Whitney U test was employed (p < 0.05).

Results

Patients characteristics at inclusion were similar. The median duration of weaning was 21 h (range 3–142 h) in the SmartCare/PS™ group and 90 h (range 4–552 h) in the usual care group, p = 0.007. The rate of reintubation within 48 h after extubation and the rate of noninvasive ventilation after extubation in the SmartCare/PS™ and usual care groups were 2/15 versus 1/15 and 2/15 versus 2/15, respectively.

Conclusions

A pediatric randomized trial on mechanical ventilation with a computerized protocol in North America is feasible. A computer-driven protocol that also manages children younger than 2 years old would help to decrease the number of PICU admissions screened in a multicentre trial on this topic.

Keywords

ComputersExtubationChildrenMechanical ventilationWeaning protocols

List of abbreviations

\( {\text{ET}}_{{{\text{CO}}_{2} }} \)

End tidal partial pressure of CO2

PEEP

Positive end expiratory pressure

PICU

Pediatric intensive care unit

BW

Body weight

PS

Pressure support

RCT

Randomised clinical trial

RR

Respiratory rate

Vt

Tidal volume

SBT

Spontaneous breathing test

Supplementary material

134_2013_2837_MOESM1_ESM.doc (44 kb)
Supplementary material 1 (DOC 44 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Philippe A. Jouvet
    • 1
  • Valérie Payen
    • 1
  • France Gauvin
    • 1
  • Guillaume Emeriaud
    • 1
  • Jacques Lacroix
    • 1
  1. 1.Pediatric ICU, Soins Intensifs PédiatriquesHôpital Sainte JustineMontrealCanada