title: Computer-driven management of prolonged mechanical ventilation and weaning: a pilot study.
abstract: 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.
authors.affiliation: 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.
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.forename: François
authors.initials: F
authors.lastname: Lellouche
authors.forename: Belen
authors.initials: B
authors.lastname: Cabello
authors.forename: Solenne
authors.initials: S
authors.lastname: Taillé
authors.forename: Jordi
authors.initials: J
authors.lastname: Mancebo
authors.forename: Michel
authors.initials: M
authors.lastname: Dojat
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: 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*