Introduction
Mechanical ventilation (MV) weaning is commonly performed using a spontaneous breathing trial (SBT) with pressure support ventilation after a daily weaning screen [1]. Recently there has been increased interest in automatic weaning trials, using respiratory rate, tidal volume and ETCO2 monitoring during SBT [1, 2]. So far there is no clinical evidence comparing an automatic weaning trial with SBT. Our study's objective was to compare MV and weaning times between Automatic Weaning Ventilation System (SmartCare™/PS) and SBT groups.
Methods
A randomized, controlled study was performed in a general ICU. We enrolled adult patients who were ventilated for more than 24 hours. Patients were randomized either to the control or SmartCare™ group. All patients were ventilated with a Drager EvitaXL (Drager Medical, Lubeck, Germany) ventilator with SmartCare™/PS software version 1.1. The control group consisted of a daily weaning screen and SBT with pressure support ventilation; if patients tolerated SBT they were extubated. SmartCare™ group patients were also submitted to a daily weaning screen, after which they were ventilated with the SmartCare™/PS mode. We evaluated the MV and weaning time, maximum inspiratory pressure, maximum expiratory pressure, vital capacity, respiratory frequency to tidal volume ratio (f/Vt), use of noninvasive ventilation (NIV) post extubation, and re-intubation rate.
Results
We evaluated a total of 70 patients (35 patients randomized in each group). There was no difference in age (P = 0.298) or gender (P = 0.08) between groups (Table 1). There was no difference in MV time between the control and SmartCare group (P = 0.534) (Table 1). Weaning duration was lower in the control group (pf/VT, P = 0.414), use of NIV post extubation (P = 0.811) and re-intubation rate (P = 1.0) (Table 1).
Conclusion
SBT showed a reduction in weaning time when compared with the SmartCare™/PS group, although there was no impact on total MV time and reintubation rate.
References
Blackwood B, Alderdice F, Burns K, et al.: Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ 2011, 342: c7237. 10.1136/bmj.c7237
Lellouche F, Mancebo J, Jolliet P, et al.: A multicenter randomized trial of computer-driven protocoled weaning from mechanical ventilation. Am J Respir Crit Care Med 2006, 174: 894-900. 10.1164/rccm.200511-1780OC
Author information
Authors and Affiliations
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Taniguchi, C., Timenetsky, K., Silva, C. et al. Spontaneous breathing trial reduces mechanical ventilation weaning when compared with SmartCare™ ventilation. Crit Care 17 (Suppl 3), P43 (2013). https://doi.org/10.1186/cc12659
Published:
DOI: https://doi.org/10.1186/cc12659