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Spontaneous breathing trial reduces mechanical ventilation weaning when compared with SmartCare™ ventilation
Critical Care volume 17, Article number: P43 (2013)
Mechanical ventilation (MV) weaning is commonly performed using a spontaneous breathing trial (SBT) with pressure support ventilation after a daily weaning screen . 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.
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.
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).
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.
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.c7237
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.200511-1780OC
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Taniguchi, C., Timenetsky, K., Silva, C. et al. Spontaneous breathing trial reduces mechanical ventilation weaning when compared with SmartCare™ ventilation. Crit Care 17 (Suppl 3), P43 (2013). https://doi.org/10.1186/cc12659
- Pressure Support Ventilation
- Noninvasive Ventilation
- Spontaneous Breathing Trial
- Maximum Inspiratory Pressure
- Maximum Expiratory Pressure