A Multicenter Randomized Trial of Computer-driven Protocolized Weaning from Mechanical Ventilation

Abstract

The specific computer-driven system used in this study can reduce mechanical ventilation duration and ICU length of stay, as compared with a physician-controlled weaning process.

Efeitos da aplicação de protocolo de desmame de ventilação mecânica em Unidade Coronária: estudo randomizado

“…When compared to the control group, the experimental group showed significant reduction of time spent on MV (7.5 vs. 12 days, P = 0.003), reintubation rates (23% vs. 46%; P = 0.4) and hospitalization period (74% vs. 15.5 days, P=0.02) [24].…”

“…In these studies, the non-use of protocol has made the time of extubation become inaccurate, resulting in early extubation and unnecessary prolongation of the duration of the weaning process [5,6,13,[16][17][18][19][20][21][22][23][24][25][26][27].…”

“…Several authors have demonstrated the importance of this result in the evolution of patients [5,12,13,[18][19][20]24,28]. When compared to the first intubation, reintubation increased eight times the risk of pneumonia and from 6 to 12 times the risk of death, being considered an independent predictor of mortality [13,14,19,29,30].…”

Ineffective efforts during mechanical ventilation: the brain wants, the machine declines

“…The increase in respiratory rate may be erroneously viewed as a sign of respiratory distress, causing unnecessary delays in the weaning process. Likewise, computerized weaning protocols in which the change in ventilator settings is based on ventilator rate, without taking into consideration the phenomenon of IE, [15] may also lead to weaning delays in this group of patients.…”

SmartCare™ closed-loop system and the altitude problem

“…The protocol was found to be efficient in a multicenter randomized trial by Lellouche et al [2]; however, it was made on cities that not exceed 100 m above the sea level (m.s.l. ), and the so-called ''comfort zone'' may differ strongly in its ideal limits at levels considered of ''low'', ''medium'' or ''high'' altitude (2,000, 3,000 and 4,000 m.s.l.)…”