Carl G Tams1, Ali Ataya2, Neil R Euliano3, Paul Stephan4, A Daniel Martin5, Hassan Alnuaimat6, Andrea Gabrielli7. 1. Convergent Engineering, 107 SW 140th Terrace, #1, Newberry, FL 32669, USA. Electronic address: carl@conveng.com. 2. Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, USA. Electronic address: Ali.ataya@medicine.ufl.edu. 3. Convergent Engineering, 107 SW 140th Terrace, #1, Newberry, FL 32669, USA. Electronic address: neil@conveng.com. 4. Convergent Engineering, 107 SW 140th Terrace, #1, Newberry, FL 32669, USA. 5. University of Florida, College of Public Health & Health Professions, Department of Physical Therapy, Gainesville, FL 32610, USA. Electronic address: dmartin@phhp.ufl.edu. 6. Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, USA. Electronic address: Hassan.alnuaimat@medicine.ufl.edu. 7. Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, USA. Electronic address: Andrea.gabrielli@uphs.upenn.edu.
Abstract
PURPOSE: A commercially available decision support system (DSS) provides guidance for setting inspiratory pressure support (PS) to maintain work of breathing (WOB/min), breathing frequency (f), and tidal volume (VT) in proper clinical ranges (VentAssist™). If these values are outside the proper clinical range patients may suffer fatigue, atrophy, hypoventilation, hyperventilation, volutrauma, or VT deficiency. The purpose of our study was to evaluate the increase of the percentage of breaths in the targeted clinical ranges when the DSS guidance for setting the PS was followed. MATERIALS AND METHODS: The study included 43 intubated adults with respiratory failure in an academic medical intensive care unit. Each of the patients had received ventilatory support for >24h with no weaning trials attempted. Clinicians switched the ventilator to PS then proceeded to utilize the guidance recommended by the DSS for setting PS for 21 patients (intervention group); while the clinicians caring for the remaining 23 patients did not have access to the DSS (control group). RESULTS: The use of a DSS to set PS level increased the percentage of breaths in the targeted clinical range [28% to 48%, p value<0.0001]. An unexpected result was that while following the DSS 18 of the 21 patients were rapidly weaned to minimal ventilator settings within 46±38min; however, when the DSS was not available weaning to minimal ventilator settings lasted 21±12h [p value<0.0001]. CONCLUSIONS: The DSS is successful at assisting clinicians on how to set PS specific to a patient's individual demands (VT and f) while accounting for their breathing effort (WOB/min). The DSS appears to promote rapid weaning of PS to minimal ventilator settings when appropriate.
PURPOSE: A commercially available decision support system (DSS) provides guidance for setting inspiratory pressure support (PS) to maintain work of breathing (WOB/min), breathing frequency (f), and tidal volume (VT) in proper clinical ranges (VentAssist™). If these values are outside the proper clinical range patients may suffer fatigue, atrophy, hypoventilation, hyperventilation, volutrauma, or VT deficiency. The purpose of our study was to evaluate the increase of the percentage of breaths in the targeted clinical ranges when the DSS guidance for setting the PS was followed. MATERIALS AND METHODS: The study included 43 intubated adults with respiratory failure in an academic medical intensive care unit. Each of the patients had received ventilatory support for >24h with no weaning trials attempted. Clinicians switched the ventilator to PS then proceeded to utilize the guidance recommended by the DSS for setting PS for 21 patients (intervention group); while the clinicians caring for the remaining 23 patients did not have access to the DSS (control group). RESULTS: The use of a DSS to set PS level increased the percentage of breaths in the targeted clinical range [28% to 48%, p value<0.0001]. An unexpected result was that while following the DSS 18 of the 21 patients were rapidly weaned to minimal ventilator settings within 46±38min; however, when the DSS was not available weaning to minimal ventilator settings lasted 21±12h [p value<0.0001]. CONCLUSIONS: The DSS is successful at assisting clinicians on how to set PS specific to a patient's individual demands (VT and f) while accounting for their breathing effort (WOB/min). The DSS appears to promote rapid weaning of PS to minimal ventilator settings when appropriate.
Authors: Stephen Edward Rees; Savino Spadaro; Francesca Dalla Corte; Nilanjan Dey; Jakob Bredal Brohus; Gaetano Scaramuzzo; David Lodahl; Robert Ravnholt Winding; Carlo Alberto Volta; Dan Stieper Karbing Journal: Biomed Eng Online Date: 2022-01-24 Impact factor: 2.819