title: A knowledge- and model-based system for automated weaning from mechanical ventilation: technical description and first clinical application.
abstract: To describe the principles and the first clinical application of a novel prototype automated weaning system called Evita Weaning System (EWS). EWS allows an automated control of all ventilator settings in pressure controlled and pressure support mode with the aim of decreasing the respiratory load of mechanical ventilation. Respiratory load takes inspired fraction of oxygen, positive end-expiratory pressure, pressure amplitude and spontaneous breathing activity into account. Spontaneous breathing activity is assessed by the number of controlled breaths needed to maintain a predefined respiratory rate. EWS was implemented as a knowledge- and model-based system that autonomously and remotely controlled a mechanical ventilator (Evita 4, Dräger Medical, Lübeck, Germany). In a selected case study (n = 19 patients), ventilator settings chosen by the responsible physician were compared with the settings 10 min after the start of EWS and at the end of the study session. Neither unsafe ventilator settings nor failure of the system occurred. All patients were successfully transferred from controlled ventilation to assisted spontaneous breathing in a mean time of 37 ± 17 min (± SD). Early settings applied by the EWS did not significantly differ from the initial settings, except for the fraction of oxygen in inspired gas. During the later course, EWS significantly modified most of the ventilator settings and reduced the imposed respiratory load. A novel prototype automated weaning system was successfully developed. The first clinical application of EWS revealed that its operation was stable, safe ventilator settings were defined and the respiratory load of mechanical ventilation was decreased.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 12, 24105, Kiel, Germany, dirk.schaedler@uksh.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Schädler
authors.forename: Stefan
authors.initials: S
authors.lastname: Mersmann
authors.forename: Inéz
authors.initials: I
authors.lastname: Frerichs
authors.forename: Gunnar
authors.initials: G
authors.lastname: Elke
authors.forename: Thomas
authors.initials: T
authors.lastname: Semmel-Griebeler
authors.forename: Oliver
authors.initials: O
authors.lastname: Noll
authors.forename: Sven
authors.initials: S
authors.lastname: Pulletz
authors.forename: Günther
authors.initials: G
authors.lastname: Zick
authors.forename: Matthias
authors.initials: M
authors.lastname: David
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Heinrichs
authors.forename: Jens
authors.initials: J
authors.lastname: Scholz
authors.forename: Norbert
authors.initials: N
authors.lastname: Weiler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D004867:Equipment Design; D006801:Humans; D051188:Knowledge Bases; D008490:Medical Informatics; D008875:Middle Aged; D008954:Models, Biological; D008991:Monitoring, Physiologic; D061214:Patient Safety; D011175:Positive-Pressure Respiration; D015656:Respiratory Mechanics; D015300:Ventilator Weaning / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data
references.citation: Eur Respir J. 2007 May;29(5):1033-56
references.pmid: 17470624
references.citation: Chest. 1991 Oct;100(4):1096-9
references.pmid: 1914564
references.citation: Am J Respir Crit Care Med. 1998 Jan;157(1):294-323
references.pmid: 9445314
references.citation: J Clin Monit Comput. 2009 Apr;23(2):93-104
references.pmid: 19263230
references.citation: Anesth Analg. 2009 Feb;108(2):565-71
references.pmid: 19151288
references.citation: Thorax. 1980 Dec;35(12):907-13
references.pmid: 7022735
references.citation: Chest. 2000 Aug;118(2):459-67
references.pmid: 10936141
references.citation: Anesthesiology. 2001 Nov;95(5):1182-8
references.pmid: 11684988
references.citation: J Clin Monit Comput. 2008 Dec;22(6):409-15
references.pmid: 19011976
references.citation: Anesthesiology. 2003 Nov;99(5):1137-44
references.pmid: 14576551
references.citation: J Appl Physiol Respir Environ Exerc Physiol. 1978 Jul;45(1):133-6
references.pmid: 276522
references.citation: Br Med J. 1974 Jun 22;2(5920):656-9
references.pmid: 4835444
references.citation: Am J Respir Crit Care Med. 2000 Apr;161(4 Pt 1):1161-6
references.pmid: 10764306
references.citation: Eur J Anaesthesiol. 2000 Oct;17(10):601-10
references.pmid: 11050517
references.citation: Crit Care Med. 2002 Jun;30(6):1224-30
references.pmid: 12072672
references.citation: N Engl J Med. 1998 Feb 5;338(6):347-54
references.pmid: 9449727
references.citation: Crit Care. 2005 Apr;9(2):R83-9
references.pmid: 15774054
references.citation: IEEE Trans Biomed Eng. 1971 Sep;18(5):330-7
references.pmid: 5284357
references.citation: Arch Surg. 1998 May;133(5):483-8; discussion 488-9
references.pmid: 9605909
references.citation: Intensive Care Med. 1996 Oct;22(10):1052-6
references.pmid: 8923069
references.citation: N Engl J Med. 2008 Mar 27;358(13):1327-35
references.pmid: 18367735
references.citation: J Clin Monit Comput. 2006 Dec;20(6):421-9
references.pmid: 16977430
references.citation: Curr Opin Crit Care. 2006 Feb;12(1):13-8
references.pmid: 16394778
references.citation: Anesthesiology. 2001 Dec;95(6):1339-45
references.pmid: 11748389
references.citation: Thorax. 2002 Jul;57(7):635-42
references.pmid: 12096209
references.citation: Chest. 2001 Jan;119(1):236-42
references.pmid: 11157610
references.citation: Crit Care Med. 2002 Apr;30(4):801-7
references.pmid: 11940749
references.citation: Minerva Anestesiol. 2006 Jun;72(6):357-62
references.pmid: 16682901
references.citation: N Engl J Med. 2004 Jul 22;351(4):327-36
references.pmid: 15269312
references.citation: J Med Syst. 1982 Feb;6(1):53-9
references.pmid: 6802916
references.citation: Am J Respir Crit Care Med. 1996 Mar;153(3):997-1004
references.pmid: 8630586
references.citation: Minerva Anestesiol. 2002 May;68(5):365-8
references.pmid: 12029247
references.citation: Anesthesiology. 2008 Jul;109(1):81-7
references.pmid: 18580176
references.citation: N Engl J Med. 1996 Dec 19;335(25):1864-9
references.pmid: 8948561
references.citation: Intensive Care Med. 2008 Oct;34(10):1788-95
references.pmid: 18575843
references.citation: IEEE Trans Inf Technol Biomed. 2004 Jun;8(2):161-72
references.pmid: 15217261
references.citation: Crit Care Med. 1997 Apr;25(4):567-74
references.pmid: 9142019
references.citation: Am J Respir Crit Care Med. 1999 Apr;159(4 Pt 1):1241-8
references.pmid: 10194172
references.citation: Anesth Analg. 2003 Dec;97(6):1743-1750
references.pmid: 14633553
references.citation: Respir Care. 2011 Jan;56(1):85-102
references.pmid: 21235841
references.citation: IEEE Trans Biomed Eng. 2004 May;51(5):823-31
references.pmid: 15132509
references.citation: N Engl J Med. 2006 Apr 27;354(17):1775-86
references.pmid: 16641394
references.citation: Intensive Care Med. 1994;20(1):64-79
references.pmid: 8163765
references.citation: Anaesthesia. 1977 Feb;32(2):163-9
references.pmid: 322535
references.citation: Artif Intell Med. 1997 Oct;11(2):97-117
references.pmid: 9332706
references.citation: Artif Intell Med. 1993 Feb;5(1):67-82
references.pmid: 8358487
references.citation: Intensive Care Med. 2012 May;38(5):781-7
references.pmid: 22460854
references.citation: Int J Artif Organs. 2004 Aug;27(8):709-16
references.pmid: 15478542
references.citation: IEEE Trans Inf Technol Biomed. 2002 Dec;6(4):269-76
references.pmid: 15224841
references.citation: Am J Respir Crit Care Med. 2010 Mar 15;181(6):578-86
references.pmid: 19910610
references.citation: Crit Care. 2007;11(1):108
references.pmid: 17300737
references.citation: Eur J Anaesthesiol. 1997 Nov;14(6):576-82
references.pmid: 9466092
references.citation: Am J Respir Crit Care Med. 2006 Oct 15;174(8):894-900
references.pmid: 16840741
references.citation: J Appl Physiol. 1949 Jun;1(12):825-47
references.pmid: 18145478
references.citation: J Trauma. 1991 Sep;31(9):1211-4; discussion 1214-5
references.pmid: 1920550
references.citation: Int J Clin Monit Comput. 1992 Dec;9(4):239-50
references.pmid: 1484275
references.citation: Respir Care Clin N Am. 2001 Sep;7(3):341-62, vii
references.pmid: 11517027
references.citation: Am J Crit Care. 2003 Sep;12(5):454-60
references.pmid: 14503429
references.citation: J Clin Monit Comput. 2008 Apr;22(2):121-30
references.pmid: 18324476
references.citation: IEEE Trans Biomed Eng. 1994 Jan;41(1):51-9
references.pmid: 8200668
references.citation: J Clin Monit Comput. 2004 Apr;18(2):111-29
references.pmid: 15362273
references.citation: Am J Respir Crit Care Med. 2001 Jul 15;164(2):225-30
references.pmid: 11463592
references.citation: Am J Respir Crit Care Med. 2012 Mar 15;185(6):637-44
references.pmid: 22268137
references.citation: Am J Respir Crit Care Med. 2001 Jul 1;164(1):43-9
references.pmid: 11435237
references.citation: Crit Care Med. 2001 Feb;29(2):297-303
references.pmid: 11246309