title: Wean earlier and automatically with new technology (the WEAN study). A multicenter, pilot randomized controlled trial.
abstract: BACKGROUND
  Automated weaning has not been compared with a paper-based weaning protocol in North America.
  
  
  OBJECTIVE
  We conducted a pilot randomized trial comparing automated weaning with protocolized weaning in critically ill adults to evaluate clinician compliance and acceptance of the weaning and sedation protocols, recruitment, and impact on outcomes.
  
  
  METHODS
  From August 2007 to October 2009, we enrolled critically ill adults requiring more than 24 hours of mechanical ventilation and at least partial reversal of the condition precipitating respiratory failure at nine Canadian intensive care units. We randomized patients who tolerated at least 30 minutes of pressure support and either failed or were not yet ready to undergo a spontaneous breathing trial to automated or protocolized weaning. Both groups used pressure support, included spontaneous breathing trials, used a common positive end-expiratory pressure-FI(O(2)) chart, sedation protocol, and criteria for extubation, reintubation, and noninvasive ventilation.
  
  
  RESULTS
  We recruited 92 patients (49 automated, 43 protocolized) over 26 months. Adherence to assigned weaning protocols and extreme sedation scale scores fell within prespecified thresholds. Combined physician-respiratory therapist and nurse acceptance scores of the study weaning and sedation protocols, respectively, were not significantly different. Automated weaning patients had significantly shorter median times to first successful spontaneous breathing trial (1.0 vs. 4.0 d; P < 0.0001), extubation (3.0 vs. 4.0 d; P = 0.02), and successful extubation (4.0 vs. 5.0 d; P = 0.01), and underwent fewer tracheostomies and episodes of protracted ventilation.
  
  
  CONCLUSIONS
  Compared with a standardized protocol, automated weaning was associated with promising outcomes that warrant further investigation. Minor protocol modifications may increase compliance, facilitate recruitment, and enhance feasibility. Clinical trial registered with www.controlled-trials.com (ISRCTN43760151).
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Karen E A
authors.initials: KE
authors.lastname: Burns
authors.forename: Maureen O
authors.initials: MO
authors.lastname: Meade
authors.forename: Martin R
authors.initials: MR
authors.lastname: Lessard
authors.forename: Lori
authors.initials: L
authors.lastname: Hand
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhou
authors.forename: Sean P
authors.initials: SP
authors.lastname: Keenan
authors.forename: Francois
authors.initials: F
authors.lastname: Lellouche
mesh_terms: D000368:Aged; D001331:Automation; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011175:Positive-Pressure Respiration / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods*