OBJECTIVE: To evaluate the feasibility of using a knowledge-based system designed to automatically titrate pressure support (PS) to maintain the patient in a "respiratory comfort zone" during noninvasive ventilation (NIV) in patients with acute respiratory failure. DESIGN AND SETTING: Prospective crossover interventional study in an intensive care unit of a university hospital. PATIENTS: Twenty patients. INTERVENTIONS: After initial NIV setting and startup in conventional PS by the chest physiotherapist NIV was continued for 45 min with the automated PS activated. MEASUREMENTS AND RESULTS: During automated PS minute-volume was maintained constant while respiratory rate decreased significantly from its pre-NIV value (20+/-3 vs. 25+/-3 bpm). There was a trend towards a progressive lowering of dyspnea. In hypercapnic patients PaCO(2) decreased significantly from 61+/-9 to 51+/-2 mmHg, and pH increased significantly from 7.31+/-0.05 to 7.35+/-0.03. Automated PS was well tolerated. Two system malfunctions occurred prompting physiotherapist intervention. CONCLUSIONS: The results of this feasibility study suggest that the system can be used during NIV in patients with acute respiratory failure. Further studies should now determine whether it can improve patient-ventilator interaction and reduce caregiver workload.
RCT Entities:
OBJECTIVE: To evaluate the feasibility of using a knowledge-based system designed to automatically titrate pressure support (PS) to maintain the patient in a "respiratory comfort zone" during noninvasive ventilation (NIV) in patients with acute respiratory failure. DESIGN AND SETTING: Prospective crossover interventional study in an intensive care unit of a university hospital. PATIENTS: Twenty patients. INTERVENTIONS: After initial NIV setting and startup in conventional PS by the chest physiotherapist NIV was continued for 45 min with the automated PS activated. MEASUREMENTS AND RESULTS: During automated PS minute-volume was maintained constant while respiratory rate decreased significantly from its pre-NIV value (20+/-3 vs. 25+/-3 bpm). There was a trend towards a progressive lowering of dyspnea. In hypercapnic patients PaCO(2) decreased significantly from 61+/-9 to 51+/-2 mmHg, and pH increased significantly from 7.31+/-0.05 to 7.35+/-0.03. Automated PS was well tolerated. Two system malfunctions occurred prompting physiotherapist intervention. CONCLUSIONS: The results of this feasibility study suggest that the system can be used during NIV in patients with acute respiratory failure. Further studies should now determine whether it can improve patient-ventilator interaction and reduce caregiver workload.
Authors: L Brochard; J Mancebo; M Wysocki; F Lofaso; G Conti; A Rauss; G Simonneau; S Benito; A Gasparetto; F Lemaire Journal: N Engl J Med Date: 1995-09-28 Impact factor: 91.245
Authors: Miquel Ferrer; Antonio Esquinas; Miguel Leon; Gumersindo Gonzalez; Antonio Alarcon; Antoni Torres Journal: Am J Respir Crit Care Med Date: 2003-09-18 Impact factor: 21.405
Authors: Peter Andrews; Elie Azoulay; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Daniel De Backer; Geoffrey Dobb; Jean-Yves Fagon; Herwig Gerlach; Johan Groeneveld; Duncan Macrae; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Jerôme Pugin; Michael Pinsky; Peter Radermacher; Christian Richard Journal: Intensive Care Med Date: 2007-01-13 Impact factor: 17.440