A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare™/PS
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Preliminary assessment of an automated weaning system (SmartCare™/PS) compared to usual management of weaning from mechanical ventilation performed in the absence of formal protocols.
Design and setting
A randomised, controlled pilot study in one Australian intensive care unit.
A total of 102 patients were equally divided between SmartCare/PS and Control.
The automated system titrated pressure support, conducted a spontaneous breathing trial and provided notification of success (“separation potential”).
Measurements and results
The median time from the first identified point of suitability for weaning commencement to the state of “separation potential” using SmartCare/PS was 20 h (interquartile range, IQR, 2–40) compared to 8 h (IQR 2–43) with Control (log-rank P = 0.3). The median time to successful extubation was 43 h (IQR 6–169) using SmartCare/PS and 40 (14–87) with Control (log-rank P = 0.6). Unadjusted, the estimated probability of reaching “separation potential” was 21% lower (95% CI, 48% lower to 20% greater) with SmartCare/PS compared to Control. Adjusted for other covariates (age, gender, APACHE II, SOFAmax, neuromuscular blockade, corticosteroids, coma and elevated blood glucose), these estimates were 31% lower (95% CI, 56% lower to 9% greater) with SmartCare/PS. The study groups showed comparable rates of reintubation, non-invasive ventilation post-extubation, tracheostomy, sedation, neuromuscular blockade and use of corticosteroids.
Substantial reductions in weaning duration previously demonstrated were not confirmed when the SmartCare/PS system was compared to weaning managed by experienced critical care specialty nurses, using a 1:1 nurse-to-patient ratio. The effect of SmartCare/PS may be influenced by the local clinical organisational context.
28. Mechanical ventilation: weaning.
KeywordsRespiration Artificial Mechanical ventilation Weaning Automated weaning Closed-loop ventilation
The authors thank the Intensive Care Unit nursing staff and nurse education team for their assistance in the completion of this study. This study was supported by The Victor Hurley Medical Research Fund, The Royal Melbourne Hospital and Australian College of Critical Care Nurses’ (ACCCN) Nursing Research Fund.
Conflict of interest statement
The authors have no potentially conflicting financial interests to be declared, but report that SmartCare/PS software, and associated technical upgrades for two ventilators, were provided free of charge to the Intensive Care Unit of The Royal Melbourne Hospital by Dräger Medical, Australia.
- 2.Lellouche F, Mancebo J, Jolliet P, Roeseler J, Schortgen F, Dojat M, Cabello B, Bouadma L, Rodriguez P, Maggiore S, Reynaert M, Mersmann S, Brochard L (2006) A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med 174:894–900PubMedCrossRefGoogle Scholar
- 6.Rose L, Presneill JJ, Cade JF (2007) A randomized, controlled trial of conventional weaning versus an automated system (SmartCare/PS) in mechanically ventilated critically-ill patients. Intensive Care Med 33:S97Google Scholar
- 9.Minitab. version 14 (2003) USA, MinitabGoogle Scholar
- 10.StataCorp. Stata Statistical Software Release 9.2 (2006) College Station, Texas, Stata CorporationGoogle Scholar
- 11.Moreno R, Vincent J, Matos R, Mendonca A, Cantraine F, Thijs L, Takala J, Sprung C, Antonelli M, Bruining H, Willato S (1999) The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Intensive Care Med 25:686–696PubMedCrossRefGoogle Scholar
- 15.Esteban A, Anzueto A, Alia I, Gordo F, Apezteguia C, Palizas F, Cide D, Goldwaser R, Soto L, Bugedo G, Rodrigo C, Pimentel J, Raimondi G, Tobin MJ (2000) How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med 161:1450–1458PubMedGoogle Scholar