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Intensive Care Med. 2008 Oct;34(10):1788-95. doi: 10.1007/s00134-008-1179-4. Epub 2008 Jun 25.

A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare/PS.

Author information

1
The University of Melbourne and Intensive Care Unit, The Royal Melbourne Hospital, Victoria, Australia. louise.rose@utoronto.ca

Abstract

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.

DESIGN AND SETTING:

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

PATIENTS:

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

INTERVENTIONS:

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

MEASUREMENTS AND 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.

DESCRIPTOR:

28. Mechanical ventilation: weaning.

Comment in

PMID:
18575843
DOI:
10.1007/s00134-008-1179-4
[Indexed for MEDLINE]
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