Computer Driven Management of Weaning Following Prolonged Mechanical Ventilation: a Pilot Study
试验速览
- 阶段
- 不适用
- 入组人数
- 50
- 主要终点
- Maintenance of spontaneous breathing
研究概览
简要总结
After an episode of acute respiratory failure requiring mechanical ventilation, weaning the patient from the ventilator may be difficult. Discontinuation of ventilation is estimated to take up to 40% of the total duration of ventilatory support. Approximately two- thirds of patients can be disconnected from the ventilator after a spontaneous breathing trial. Prolongation of mechanical ventilation may increase the risk of adverse events such as infections and can increase morbidity and mortality.
Identifying weaning readiness early and reliably is therefore crucial. Weaning protocols developed to assist in identifying weaning readiness have been shown to shorten duration of mechanical ventilation, most notably the weaning period.
Closed loop knowledge-based systems serve as a continuously applied weaning process that automatically reduce ventilatory assistance according to patient ability and indicate when the patient is ready for disconnection. No data on the use of such a computer driven system (CDS) in elderly patients requiring prolonged ventilation in weaning centers (non ICU) have been reported.
The Objective of the present study is to evaluate the ability of a computer driven system to predict weaning readiness and to compare this to a physician-directed protocol. The CDS continuously adapts pressure support, gradually decreasing ventilator assistance according to patient ability, and thus indicates weaning readiness. Patients who maintain spontaneous breathing for 7 days following weaning will be considered to be successfully weaned from mechanical ventilation.
详细描述
Introduction.
After an episode of acute respiratory failure requiring mechanical ventilation, weaning the patient from the ventilator may be difficult. Discontinuation of ventilation is estimated to take up to 40% of the total duration of ventilatory support. Approximately two- thirds of patients can be disconnected from the ventilator after a spontaneous breathing trial. Prolongation of mechanical ventilation may increase the risk of adverse events such as infections and can increase morbidity and mortality.
Identifying weaning readiness early and reliably is therefore crucial. Weaning protocols developed to assist in identifying weaning readiness have been shown to shorten duration of mechanical ventilation, most notably the weaning period.
Closed loop knowledge-based systems serve as a continuously applied weaning process that automatically reduce ventilatory assistance according to patient ability and indicate when the patient is ready for disconnection. No data on the use of such a computer driven system (CDS) in elderly patients requiring prolonged ventilation in weaning centers (non ICU) have been reported.
Objective:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 60 Years 至 85 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Pressure support ventilation (PSV) for at least 48 h,
- •Plateau pressure less than 30 cmH2O,
- •PEEP < 6 cmH2O, PaO2/FIO2 ratio > 150 or SaO2 > 94% with FIO2 < than 0.5,
- •pCO2 <55 mm Hg for normal patients and < 65 m Hg for patients with COPD,
- •No requirement for inotropic support,
- •Body temperature > 36.50C and < 38.50 C,
- •Stable neurological status with Glasgow Coma Score (GCS) > 6, HgB > 8 mg %,
- •Systolic blood pressure >90 mg Hg,
- •Mean arterial pressure >65 mg Hg,
- •Absence of sedative medications and availability of CDS at the time of patient admission or switching to pressure support ventilation (PSV).
排除标准
- •Patients younger than 60 or older than 85 years of age,
- •Patients on chronic ventilatory assistance at home; and
- •Patients with decision to limit life-sustaining treatments
结局指标
主要结局
Maintenance of spontaneous breathing
时间窗: 7 days
次要结局
未报告次要终点