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, Crteil, 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.
Laurent J. Brochard, M.D., of the Hpital Henri Mondor in Crteil, 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 tracheotomy (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."