OBJECTIVE: 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. PATIENTS: A total of 102 patients were equally divided between SmartCare/PS and Control. INTERVENTIONS: 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. CONCLUSIONS: 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. DESCRIPTOR: 28. Mechanical ventilation: weaning.
RCT Entities:
OBJECTIVE: 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. PATIENTS: A total of 102 patients were equally divided between SmartCare/PS and Control. INTERVENTIONS: 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. CONCLUSIONS: 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. DESCRIPTOR: 28. Mechanical ventilation: weaning.
Authors: Andrés Esteban; Antonio Anzueto; Fernando Frutos; Inmaculada Alía; Laurent Brochard; Thomas E Stewart; Salvador Benito; Scott K Epstein; Carlos Apezteguía; Peter Nightingale; Alejandro C Arroliga; Martin J Tobin Journal: JAMA Date: 2002-01-16 Impact factor: 56.272
Authors: R Moreno; J L Vincent; R Matos; A Mendonça; F Cantraine; L Thijs; J Takala; C Sprung; M Antonelli; H Bruining; S Willatts Journal: Intensive Care Med Date: 1999-07 Impact factor: 17.440
Authors: J-M Boles; J Bion; A Connors; M Herridge; B Marsh; C Melot; R Pearl; H Silverman; M Stanchina; A Vieillard-Baron; T Welte Journal: Eur Respir J Date: 2007-05 Impact factor: 16.671
Authors: Jerry A Krishnan; Dana Moore; Carey Robeson; Cynthia S Rand; Henry E Fessler Journal: Am J Respir Crit Care Med Date: 2004-01-15 Impact factor: 21.405
Authors: Leopoldo N Segal; Erwin Oei; Beno W Oppenheimer; Roberta M Goldring; Rami T Bustami; Salvatore Ruggiero; Kenneth I Berger; Stanley B Fiel Journal: Intensive Care Med Date: 2009-11-28 Impact factor: 17.440