Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children

Rose, Louise; Schultz, Marcus J.; Cardwell, Chris R; Jouvet, Philippe; Blackwood, Bronagh

doi:10.1002/14651858.cd009235

Cited by 7 publications

(6 citation statements)

References 46 publications

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“…In adults, progressively decreasing PS levels were associated with increasing breathing rate but no change in pCO 2 12 and similar findings have also been reported in neonates 10 . For adults, a proprietary automated weaning protocol (SmartCare™; Dräger) has been developed to adjust PS level based on respiratory rate and tcCO 2 and it has been shown to reduce the duration of mechanical ventilation 13,14 . In our study, when PIP of the VG inflations (PIP VG ) was relatively low compared to the PS level, babies had a higher respiratory rate.…”

Section: Discussionsupporting

confidence: 84%

Synchronized intermittent mandatory ventilation with volume guarantee and pressure support in neonates: Detailed analysis of ventilator parameters

Balajthy

Balázs

Kovács

et al. 2023

Pediatric Pulmonology

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Objective: To analyse the relationship between peak inflating pressure, expired tidal volume, respiratory rate, and inspiratory time of volume-guaranteed ventilator inflations and pressure-supported spontaneous breaths during synchronized intermittent positive pressure mode with volume guarantee and pressure support (SIMV-VG-PS) in neonates.Methods: Ventilator parameters were downloaded every second from 16 babies ventilated with SIMV-VG-PS mode using Dräger Babylog VN500 ventilators over 137 days. Transcutaneous carbon dioxide (tcCO 2 ) data were also collected. Data were computationally analysed using Python. The average of each ventilator parameter was determined during each minute separately for ventilator inflations and for spontaneous breaths. These values were compared and their effect on tcCO 2 levels was also analysed. Results:The relationship between the peak inflating pressure of the volume guaranteed inflations (PIP VG ) and pressure-supported spontaneous breaths (PIP PS ) was highly variable. The PIP PS /PIP VG ratio differed significantly from the value (0.66) targeted by clinicians (group median: 0.80, range: 0.50-1.00). PIP PS frequently exceeded PIP VG . When PIP PS /PIP VG was >0.66, the expired tidal volume and the rate of the pressure-supported spontaneous breaths were also significantly (p < 0.0001) higher, but there was no difference in tcCO 2 levels. The flow-cycled spontaneous breaths had significantly shorter inspiratory times than ventilator inflations.Conclusions: During SIMV-VG-PS it is difficult to ensure a pressure support level proportionate to the inflating pressure of ventilator inflations and to achieve the stability of tidal volumes.

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Section: Discussionsupporting

confidence: 84%

Synchronized intermittent mandatory ventilation with volume guarantee and pressure support in neonates: Detailed analysis of ventilator parameters

Balajthy

Balázs

Kovács

et al. 2023

Pediatric Pulmonology

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“…Cochran’s Q test ( 29 ) and the inconsistency index ( I 2 ) ( 30 ) were next calculated for assessment of heterogeneity. We considered P<0.05 and I 2 >50% to indicate significant heterogeneity ( 31 , 32 ). In this case, we checked the data and statistical methods again, and conducted sensitivity analysis or subgroup analysis to analyze the reasons for heterogeneity.…”

Section: Methodsmentioning

confidence: 99%

MDM2 SNP309 polymorphism is associated with lung cancer risk in women: A meta-analysis using METAGEN

Long

Xian

et al. 2012

Experimental and Therapeutic Medicine

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Lung cancer is the most common diagnosed malignancy and the leading cause of cancer-related mortality worldwide. Murine double minute 2 (MDM2) SNP309 polymorphisms have been reported to influence the risk of lung cancer. However, the published studies together with four subsequent meta-analyses have yielded contradictory results. To examine this inconsistency, we conducted a meta-analysis of 6,696 lung cancer cases and 7,972 controls from eight published case-control studies using METAGEN. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with STATA software and used to assess the strength of the association. In the overall analysis, a significant association between MDM2 SNP309 polymorphism and lung cancer risk was observed (OR, 1.143; 95% CI, 1.047–1.247). Moreover, stratified by ethnicity, a significant association was found in Asians (OR, 1.260; 95% CI, 1.111–1.429), but not in Europeans. Subgroup analysis of gender, histology and smoking status suggested that the MDM2 SNP309 genotype was associated with increased lung cancer risk in women (OR, 1.282; 95% CI, 1.062–1.548) and never smokers (OR, 1.328; 95% CI, 1.119–1.575). No statistically significant association was observed in males and ever smoking population, and no association was found in subgroup analysis based on histology. In conclusion, the association between MDM2 SNP309 and lung cancer was statistically significant, particularly in Asians, women and never smoking population.

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“…In addition, the use of automated weaning protocols has produced similar outcomes. 8,17 Currently, a preferred sedation strategy is to use a standardized SV protocol for mechanically ventilated patients. 18,19 The protocol for SVs varies among institutions.…”

mentioning

confidence: 99%

Successful Implementation of an Automated Sedation Vacation Process in Intensive Care Units

et al. 2016

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This quality improvement initiative sought to develop a sedation vacation (SV) protocol to increase SV performance and ensure sustainability. A standardized, nurse-driven SV protocol within the electronic medical record was implemented in adult intensive care units (ICUs) at Boston Medical Center. For 6 months, data were collected on the number of assessments performed, SV completion, SV eligibility, and reason for exclusion. Secondary outcomes included ICU length of stay (LOS) and ventilator LOS. Of 1730 patient-days during this 6-month period, SV assessments were performed 70% (n = 1211) of the time. SVs were conducted on 60.0% (n = 726) during days in which an assessment occurred. There was no significant change in ICU LOS or ventilator LOS during the study period. This SV protocol attained a 70% adherence rate, which was sustained over the 6-month period. There were no significant changes in secondary outcomes.

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Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children

Cited by 7 publications

References 46 publications

Synchronized intermittent mandatory ventilation with volume guarantee and pressure support in neonates: Detailed analysis of ventilator parameters

Synchronized intermittent mandatory ventilation with volume guarantee and pressure support in neonates: Detailed analysis of ventilator parameters

MDM2 SNP309 polymorphism is associated with lung cancer risk in women: A meta-analysis using METAGEN

Successful Implementation of an Automated Sedation Vacation Process in Intensive Care Units

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