Computer-driven management of prolonged mechanical ventilation and weaning: a pilot study.
OBJECTIVE
To evaluate the ability of a computer-driven system (CDS) to manage pressure-support ventilation over prolonged periods and to predict weaning readiness compared to intensivists. The system continuously adapts pressure support, gradually decreases ventilatory assistance when possible, and indicates weaning readiness.


METHODS
A two-center, prospective, open, clinical, pilot study in medical ICUs of two university hospitals.


METHODS
42 consecutive mechanically ventilated patients (60+/-14 years, SAPS II 39+/-15), 9 of whom were excluded.


METHODS
As soon as patients could tolerate pressure support, they were ventilated with the CDS. The times of weaning readiness determined by the intensivists and CDS were compared.


RESULTS
Weaning was successful in 25 patients and failed in 7; unplanned extubation occurred in 1 patient. Time on CDS ventilation was 3+/-3 days (maximum, 12 days). The CDS detected weaning readiness earlier than the intensivists in 17 patients, and intensivists earlier than the CDS in 4; in 11 patients detection times coincided.


CONCLUSIONS
A CDS was successful in fully managing pressure-support ventilation over prolonged periods and often proposed weaning readiness earlier than the intensivists did. Use of this CDS may reduce the duration of mechanical ventilation.
Bouadma
Lila
L
Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Teaching Hospital, AP-HP, 51 av. du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
Lellouche
François
F
Cabello
Belen
B
Taillé
Solenne
S
Mancebo
Jordi
J
Dojat
Michel
M
Brochard
Laurent
L
D000328:Adult; D003201:Computers; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000401:mortality / Q000628:therapy*; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D015300:Ventilator Weaning / Q000379:methods*