A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare™/PS

Rose, Louise; Presneill, Jeffrey; Johnston, Linda; Cade, J. F.

doi:10.1007/s00134-008-1179-4

Cited by 142 publications

(96 citation statements)

References 15 publications

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“…Investigators in some of these trials hypothesized that their results may have been influenced by existing good team communication, increased frequency of decision making, and empowerment of nonphysicians to make and act on decisions in the usual-care (control) group. [9][10][11][12][13] In the past decade, a few randomized controlled trials of weaning protocols in children also have yielded discordant results. [14][15][16][17][18] Similar components of complex clinical interventions that affect outcomes of weaning protocol trials may exist in adult ICUs and PICUs.…”

mentioning

confidence: 99%

Role Responsibilities in Mechanical Ventilation and Weaning in Pediatric Intensive Care Units: A National Survey

Blackwood¹,

Junk²,

Lyons³

et al. 2013

American Journal of Critical Care

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Background Organizational processes affect the duration of mechanical ventilation in adult and pediatric intensive care units, but surprisingly little is known about role responsibilities for mechanical ventilation and weaning and related contextual factors that may influence timely liberation from mechanical ventilation. Objective To determine the professional group and seniority of clinicians responsible for key decisions regarding ventilation and weaning; use of ventilation protocols and automated closed loop systems; and provision of education on mechanical ventilation. Methods Mailed survey to nurse managers of pediatric intensive care units in the United Kingdom. Results Response rate was 61%. In most units, nurse managers reported that physicians and nurses usually collaborated in making decisions about initializing (63%) and adjusting (94%) ventilator settings and for determining weaning readiness (88%), weaning method (59%), extubation readiness (82%), and weaning failure (100%). Protocols for mechanical ventilation were available in 35% of units, some specific to weaning (18%) and others for noninvasive ventilation (35%). Automated closed loop systems were used in 18% of units. Competency training was required before nurses could adjust ventilator settings in 35% of responding units; in the remaining units, settings were adjusted by nurses who had no specific competency training. Conclusions Key decisions were mainly collaborative, but nurses were limited in their ability to adjust ventilator settings independently. This limitation may be due to a lack of standardized competency programs and the infrequent use of non-physician-led weaning protocols and automated systems. These findings indicate some ways of improving processes to avoid delays in ventilator weaning.

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mentioning

confidence: 99%

Role Responsibilities in Mechanical Ventilation and Weaning in Pediatric Intensive Care Units: A National Survey

Blackwood¹,

Junk²,

Lyons³

et al. 2013

American Journal of Critical Care

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“…Moreover, intensive care unit (ICU) staff experience with PSV is necessary to set the appropriate level of pressure [2][3][4]. Closed-loop modes and automated weaning procedures aim to set the most appropriate supporting pressure levels for the patient and promote early extubation, with conflicting results [5][6][7][8].…”

mentioning

confidence: 99%

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

Kıraklı

Özdemir

Uçar

et al. 2011

European Respiratory Journal

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Adaptive support ventilation (ASV) is a closed-loop ventilation mode that can act both as pressure support ventilation (PSV) and pressure-controlled ventilation. Weaning with ASV shows promising results, mainly in post-cardiac surgery patients. The aim of the present randomised controlled study was to test the hypothesis that weaning with ASV could reduce the weaning duration in patients with chronic obstructive pulmonary disease (COPD) when compared with PSV.From among 435 COPD patients admitted to the intensive care unit (ICU) during a 20-month period, 97 were enrolled. Patients were assigned at random to either ASV or PSV as a weaning mode.Compared with PSV, ASV provided shorter weaning times (median 24 (interquartile range 20-62) h versus 72 (24-144) h, p50.041) with similar weaning success rates (35 out of 49 for ASV and 33 out of 48 for PSV). Length of stay in the ICU was also shorter with ASV but the difference was not statistically significant.This study suggests that ASV may be used in the weaning of COPD patients with the advantage of shorter weaning times. Further studies are needed to investigate the role and potential advantages of ASV in the weaning period of different patient groups.

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“…The reduction in the weaning time was associated with a decrease in both the total duration of MV (7.5 versus 12.0 days; p = 0.003) and the ICU length of stay (12.0 versus 15.5 days; p = 0.02). In contrast to the positive findings of Lellouche and colleagues, Rose et al 39 reported that SmartCare ® /PSV did not reduce weaning times. The differences on the results were due to the use of 1:1 patient-nurse ratio, the higher experience on weaning of the ICU staff, and the early exclusion of patients who tolerated PSV (within 24 hours).…”

Section: Closed-loop Modalities and Weaningmentioning

confidence: 68%

The Process of Weaning from Mechanical Ventilation

Aguirre-Bermeo¹,

Mancebo²

2016

BRN

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Mechanical ventilation is a common process in intensive care units. The weaning period has to be initiated as soon as possible because a delay in recognition that weaning can begin may prolong the duration of mechanical ventilation unnecessarily. The inappropriate management of weaning could influence outcomes; therefore, patients on weaning require continuous attention and intervention. The main objective of this review is to provide a description of the entire scenario and update on outcomes and common recommendations for the correct management of this complex process. The role of modern ventilator modes and non-invasive mechanical ventilation are discussed. Finally, the description and outcomes of a group of patients who have poor outcomes (prolonged weaning group), the importance of their identification, and suggestions for their general management are also presented. (BRN Rev. 2016;2:185-97)

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A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare™/PS

Cited by 142 publications

References 15 publications

Role Responsibilities in Mechanical Ventilation and Weaning in Pediatric Intensive Care Units: A National Survey

Role Responsibilities in Mechanical Ventilation and Weaning in Pediatric Intensive Care Units: A National Survey

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial

The Process of Weaning from Mechanical Ventilation

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