A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare/PS.
OBJECTIVE
Preliminary assessment of an automated weaning system (SmartCare/PS) compared to usual management of weaning from mechanical ventilation performed in the absence of formal protocols.


METHODS
A randomised, controlled pilot study in one Australian intensive care unit.


METHODS
A total of 102 patients were equally divided between SmartCare/PS and Control.


METHODS
The automated system titrated pressure support, conducted a spontaneous breathing trial and provided notification of success ("separation potential").


RESULTS
The median time from the first identified point of suitability for weaning commencement to the state of "separation potential" using SmartCare/PS was 20 h (interquartile range, IQR, 2-40) compared to 8 h (IQR 2-43) with Control (log-rank P = 0.3). The median time to successful extubation was 43 h (IQR 6-169) using SmartCare/PS and 40 (14-87) with Control (log-rank P = 0.6). Unadjusted, the estimated probability of reaching "separation potential" was 21% lower (95% CI, 48% lower to 20% greater) with SmartCare/PS compared to Control. Adjusted for other covariates (age, gender, APACHE II, SOFAmax, neuromuscular blockade, corticosteroids, coma and elevated blood glucose), these estimates were 31% lower (95% CI, 56% lower to 9% greater) with SmartCare/PS. The study groups showed comparable rates of reintubation, non-invasive ventilation post-extubation, tracheostomy, sedation, neuromuscular blockade and use of corticosteroids.


CONCLUSIONS
Substantial reductions in weaning duration previously demonstrated were not confirmed when the SmartCare/PS system was compared to weaning managed by experienced critical care specialty nurses, using a 1:1 nurse-to-patient ratio. The effect of SmartCare/PS may be influenced by the local clinical organisational context.


BACKGROUND
28. Mechanical ventilation: weaning.
Rose
Louise
L
The University of Melbourne and Intensive Care Unit, The Royal Melbourne Hospital, Victoria, Australia. louise.rose@utoronto.ca
Presneill
Jeffrey J
JJ
Johnston
Linda
L
Cade
John F
JF
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013813:Therapy, Computer-Assisted; D015300:Ventilator Weaning / Q000379:methods*