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Evaluation of patient parameters that predict success using the SmartCare weaning system

Introduction

Our aim was to assess the success of the SmartCare (SC) weaning system, to see what associated factors made a successful wean more likely. SC is a knowledge-based weaning system integrated into the Dräger EvitaXL ventilator, designed to optimise the ventilator settings during weaning so that patients can be weaned as quickly as possible.

Methods

The first 100 consecutive general ICU patients where SC weaning had been attempted were identified. Patient age, sex, APACHE score, diagnosis, worst FiO2 prior to weaning, duration of ventilation prior to weaning, duration of weaning attempt, need for tracheostomy and duration of stay were collected. The patients were then subdivided into unsuccessful and successful weaning attempts based upon whether they required subsequent ventilatory support during the first 48 hours after their weaning ended. The two groups were then analysed to identify the characteristics of the patients where a successful SC wean was achieved.

Results

After excluding patients whose weaning was interrupted by transfer or a decision to withdraw treatment, we had 89 weaning attempts to analyse. These represented 43 successful (S) and 46 unsuccessful (US) weans. Comparison of mean ± SD ages (S 61 ± 14.3 years, US 57.3 ± 16.1 years, P = 0.28) and APACHE scores (S 16.2 ± 4.9, US 17.7 ± 6.5, P = 0.23) for the two groups showed no major differences. Logistic regression demonstrated that the worst FiO2 prior to weaning and the duration of ventilation prior to weaning were both significantly associated with an unsuccessful SC weaning attempt (P = 0.002 and P = 0.005, respectively). ROC curve analysis suggested patients with an FiO2 below 0.47 and a duration of ventilation prior to weaning of below 43 hours were more likely to be successfully weaned.

Conclusion

SC proved most successful in those patients who had a lower worst FiO2 prior to weaning and a lower duration of ventilation prior to commencing weaning.

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Jackson, P., Mills, G. Evaluation of patient parameters that predict success using the SmartCare weaning system. Crit Care 11, P176 (2007). https://doi.org/10.1186/cc5336

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Keywords

  • Public Health
  • Logistic Regression
  • Emergency Medicine
  • Curve Analysis
  • Ventilatory Support