For patients with acute respiratory failure, a computer-driven system can significantly reduce the duration of mechanical ventilation and length of stay in the intensive care unit (ICU), as compared with the traditional physician-controlled weaning process.
The study, which was conducted in five medical-surgical ICUs in Barcelona, Brussels, Créteil, Geneva and Paris, appears in the second issue for October 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
AdvertisementLaurent J. Brochard, M.D., of the Hôpital Henri Mondor in Créteil, France, and 12 associates weaned 74 patients using the computer-driven system and 70 with the usual process. They found the computerized system reduced the duration of mechanical ventilation from 12 days to 7.5 days and cut patients' ICU stay from 15.5 days to 12 days.
"The computerized protocol included an automatic gradual reduction in pressure support, automatic performance of spontaneous breathing trials and generation of an incentive message when the patient's spontaneous breathing trial was successfully passed," said Dr. Brochard.
According to the researchers, the total number of ventilator-related complications such as reintubation, self-removal from ventilator assistance, need for noninvasive ventilation, mechanical ventilation longer than 21 days, and tracheostomy (surgically opening the trachea), was reduced by 30 percent in the computer-driven weaning group.
"The system used in the study was developed several years ago and has been repeatedly evaluated since then," said Dr. Brochard. "It ensures that the desired ventilation protocol is applied. In the usual weaning group, weaning was performed according to local guidelines, representing the usual care in the university centers involved in respiratory and weaning research."
The authors noted that automation of the weaning protocol could explain an essential part of their results. The system was designed to perform several tasks comparable to a ventilator weaning protocol 24 hours a day, seven days a week. It automatically and gradually reduced the ventilatory assistance to the patient; it performed the equivalent of a spontaneous breathing test; and it displayed an incentive message for the doctor and technicians when the patient was deemed ready to breathe spontaneously.
"The computer-driven weaning protocol does not depend on the willingness or availability of the staff, and full compliance with the weaning protocol is therefore ensured," said Dr. Brochard.
The investigators said that the message delivered by the computerized system also constituted a strong incentive for the clinician to consider possible removal from ventilator breathing assistance for the patient.
In an editorial on the research in the same issue of the journal, Gordon D. Rubenfeld, M.D., M.Sc., of Harborview Medical Center in Seattle, wrote: "Every year in industrialized nations, hundreds of thousands of people require mechanical ventilation for acute respiratory failure. We have evidence to improve outcomes in these areas with protocols for acute lung injury and weaning, but need strategies to make sure every patient has access to this care."
"Some physicians may find computer-based protocols more acceptable than sharing responsibility with a respiratory therapist or nurse," he continued. "Computer-based protocols may be more effective, less expensive or more reliable than implementation by non-physician clinicians. Hopefully, future studies of this technology will explore these questions with appropriate comparisons and measurements. In the meantime, it is refreshing to see the debate move from whether we should have non-physician-driven protocolized mechanical ventilation to how we might demonstrate and implement these protocols."
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