Volume 17 Supplement 3

Seventh International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Spontaneous breathing trial reduces mechanical ventilation weaning when compared with SmartCare™ ventilation

  • C Taniguchi1,
  • KT Timenetsky1,
  • CSM Silva1,
  • E Giovanetti1,
  • R Henn1,
  • RAC Eid1 and
  • CSV Barbas1
Critical Care201317(Suppl 3):P43

https://doi.org/10.1186/cc12659

Published: 19 June 2013

Introduction

Mechanical ventilation (MV) weaning is commonly performed using a spontaneous breathing trial (SBT) with pressure support ventilation after a daily weaning screen [1]. Recently there has been increased interest in automatic weaning trials, using respiratory rate, tidal volume and ETCO2 monitoring during SBT [1, 2]. So far there is no clinical evidence comparing an automatic weaning trial with SBT. Our study's objective was to compare MV and weaning times between Automatic Weaning Ventilation System (SmartCare™/PS) and SBT groups.

Methods

A randomized, controlled study was performed in a general ICU. We enrolled adult patients who were ventilated for more than 24 hours. Patients were randomized either to the control or SmartCare™ group. All patients were ventilated with a Drager EvitaXL (Drager Medical, Lubeck, Germany) ventilator with SmartCare™/PS software version 1.1. The control group consisted of a daily weaning screen and SBT with pressure support ventilation; if patients tolerated SBT they were extubated. SmartCare™ group patients were also submitted to a daily weaning screen, after which they were ventilated with the SmartCare™/PS mode. We evaluated the MV and weaning time, maximum inspiratory pressure, maximum expiratory pressure, vital capacity, respiratory frequency to tidal volume ratio (f/Vt), use of noninvasive ventilation (NIV) post extubation, and re-intubation rate.

Results

We evaluated a total of 70 patients (35 patients randomized in each group). There was no difference in age (P = 0.298) or gender (P = 0.08) between groups (Table 1). There was no difference in MV time between the control and SmartCare group (P = 0.534) (Table 1). Weaning duration was lower in the control group (pf/VT, P = 0.414), use of NIV post extubation (P = 0.811) and re-intubation rate (P = 1.0) (Table 1).
Table 1

Characteristics of patients between SmartCare™ and control groups

 

SmartCare™

Control

P value*

Idade

60 (46 to 77)

65 (57 to 81)

0.298

Gender, male

23 (65)

16 (45)

0.07

MIP

45 (40 to 53)

40 (36 to 50)

0.272

MEP

40 (30 to 59)

40 (21 to 44)

0.059

VC

1,200 (900 to 1,850)

1,000 (500 to 1,600)

0.834

f/Vt

35 (24 to 55)

40 (26 to 68)

0.414

MV time

4 (2 to 6)

3 (2 to 7)

0.534

Weaning time

110 (80 to 120)

60 (50 to 80)

<0.001

Use of NIV post extubation

18 (51.4)

16 (45.7)

0.811

Reintubation rate

2 (5.7)

2 (5.7)

1.00

Data presented as median (interquartile range) or n (%). f/VT, respiratory rate to tidal volume ratio; MEP, maximum expiratory pressure; MIP, maximum inspiratory pressure; MV, mechanical ventilation; NIV, noninvasive ventilation; VC, vital capacity. *P value significant <0.05.

Conclusion

SBT showed a reduction in weaning time when compared with the SmartCare™/PS group, although there was no impact on total MV time and reintubation rate.

Authors’ Affiliations

(1)
Albert Einstein Jewish Hospital

References

  1. Blackwood B, Alderdice F, Burns K, et al.: Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ 2011, 342: c7237. 10.1136/bmj.c7237PubMed CentralView ArticlePubMedGoogle Scholar
  2. Lellouche F, Mancebo J, Jolliet P, et al.: A multicenter randomized trial of computer-driven protocoled weaning from mechanical ventilation. Am J Respir Crit Care Med 2006, 174: 894-900. 10.1164/rccm.200511-1780OCView ArticlePubMedGoogle Scholar

Copyright

© Taniguchi et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Advertisement