Savino Spadaro1, Dan Stieper Karbing2, Francesca Dalla Corte1, Tommaso Mauri3, Federico Moro1, Antonio Gioia1, Carlo Alberto Volta1, Stephen Edward Rees4. 1. Department of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Arcispedale Sant' Anna, University of Ferrara, Ferrara, Italy. 2. Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. 3. Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 4. Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. Electronic address: sr@hst.aau.dk.
Abstract
PURPOSE: To assess whether a clinical decision support system (CDSS) suggests PS and FIO2 maintaining appropriate breathing effort, and minimizing FIO2. MATERIALS: Prospective, cross-over study in PS ventilated ICU patients. Over support (150% baseline) and under support (50% baseline) were applied by changing PS (15 patients) or PEEP (8 patients). CDSS advice was followed. Tension time index of inspiratory muscles (TTies), respiratory and metabolic variables were measured. RESULTS: PS over support (median 8.0 to 12.0 cmH2O) reduced respiratory muscle activity (TTies 0.090 ± 0.028 to 0.049 ± 0.030; p < .01), and tended to increase tidal volume (VT: 8.6 ± 3.0 to 10.1 ± 2.9 ml/kg; p = .08). CDSS advice reduced PS (6.0 cmH2O, p = .005), increased TTies (0.076 ± 0.038, p < .01), and tended to reduce VT (8.9 ± 2.4 ml/kg, p = .08). PS under support (12.0 to 4.0 cmH2O) slightly increased respiratory muscle activity, (TTies to 0.120 ± 0.044; p = .007) with no significant CDSS advice. CDSS advice reduced FIO2 by 12-14% (p = .005), resulting in median SpO2 = 96% (p < .02). PEEP changes did not result in changes in physiological variables, or CDSS advice. CONCLUSION: The CDSS advised on low values of PS often not prohibiting extubation, while acting to preserve respiratory muscle function and preventing passive lung inflation. CDSS advice minimized FIO2 maintaining SpO2 at safe and beneficial values.
PURPOSE: To assess whether a clinical decision support system (CDSS) suggests PS and FIO2 maintaining appropriate breathing effort, and minimizing FIO2. MATERIALS: Prospective, cross-over study in PS ventilated ICU patients. Over support (150% baseline) and under support (50% baseline) were applied by changing PS (15 patients) or PEEP (8 patients). CDSS advice was followed. Tension time index of inspiratory muscles (TTies), respiratory and metabolic variables were measured. RESULTS:PS over support (median 8.0 to 12.0 cmH2O) reduced respiratory muscle activity (TTies 0.090 ± 0.028 to 0.049 ± 0.030; p < .01), and tended to increase tidal volume (VT: 8.6 ± 3.0 to 10.1 ± 2.9 ml/kg; p = .08). CDSS advice reduced PS (6.0 cmH2O, p = .005), increased TTies (0.076 ± 0.038, p < .01), and tended to reduce VT (8.9 ± 2.4 ml/kg, p = .08). PS under support (12.0 to 4.0 cmH2O) slightly increased respiratory muscle activity, (TTies to 0.120 ± 0.044; p = .007) with no significant CDSS advice. CDSS advice reduced FIO2 by 12-14% (p = .005), resulting in median SpO2 = 96% (p < .02). PEEP changes did not result in changes in physiological variables, or CDSS advice. CONCLUSION: The CDSS advised on low values of PS often not prohibiting extubation, while acting to preserve respiratory muscle function and preventing passive lung inflation. CDSS advice minimized FIO2 maintaining SpO2 at safe and beneficial values.
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Authors: Ewan C Goligher; Martin Dres; Bhakti K Patel; Sarina K Sahetya; Jeremy R Beitler; Irene Telias; Takeshi Yoshida; Katerina Vaporidi; Domenico Luca Grieco; Tom Schepens; Giacomo Grasselli; Savino Spadaro; Jose Dianti; Marcelo Amato; Giacomo Bellani; Alexandre Demoule; Eddy Fan; Niall D Ferguson; Dimitrios Georgopoulos; Claude Guérin; Robinder G Khemani; Franco Laghi; Alain Mercat; Francesco Mojoli; Coen A C Ottenheijm; Samir Jaber; Leo Heunks; Jordi Mancebo; Tommaso Mauri; Antonio Pesenti; Laurent Brochard Journal: Am J Respir Crit Care Med Date: 2020-10-01 Impact factor: 30.528
Authors: M P Vizcaychipi; Laura Martins; James R White; Dan Stleper Karbing; Amandeep Gupta; Suveer Singh; Leyla Osman; Jeronimo Moreno-Cuesta; Steve Rees Journal: BMJ Open Date: 2020-09-02 Impact factor: 2.692