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Automatic Control of Pressure Support for Ventilator Weaning in Surgical Intensive Care Patients.
MedLine Citation:
PMID:  22268137     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
RATIONALE: In spite of its ability to reduce overall ventilation time, protocol-guided weaning from mechanical ventilation is not routinely used in daily clinical practice. Clinical implementation of weaning protocols could be facilitated by integration of knowledge-based, closed loop-controlled protocols into respirators. OBJECTIVE: To determine whether automated weaning decreases overall ventilation time compared to weaning based on a standardized written protocol in an unselected surgical patient population. METHODS: In this prospective controlled trial patients ventilated for longer than 9 hours were randomly allocated to either receive weaning with automatic control of pressure support ventilation (automated-weaning group) or weaning based on a standardized written protocol (control group) using the same ventilation mode. The primary end point of the study was overall ventilation time. MEASUREMENTS AND MAIN RESULTS: Overall ventilation time (median [25th and 75th percentile]) did not significantly differ between the automated-weaning (31 [19-101] hours, n=150) and the control groups (39 [20-118] hours, n=150, p=0.178). Patients who underwent cardiac surgery (n=132) exhibited significantly shorter overall ventilation times in the automated-weaning (24 [18-57] hours) than in the control group (35 [20-93] hours, p=0.035). The automated-weaning group exhibited shorter ventilation times until the first spontaneous breathing trial (1 [0-15] versus 9 [1-51] hours; p=0.001) and a trend towards less tracheostomies (17 versus 28; p=0.075). CONCLUSIONS: Overall ventilation times did not significantly differ between weaning using automatic control of pressure support ventilation and weaning based on a standardized written protocol. Patients after cardiac surgery may benefit from automated weaning. Implementation of additional control variables besides the level of pressure support may further improve automated-weaning systems.
Authors:
Dirk Schädler; Christoph Engel; Gunnar Elke; Sven Pulletz; Nils Haake; Inéz Frerichs; Günther Zick; Jens Scholz; Norbert Weiler
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-20
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  -     ISSN:  1535-4970     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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