Comparison of automated protocol-based versus non-protocol-based physician-directed weaning from mechanical ventilation

Stahl, C; G, Dahmen; Ziegler, Andreas; Muhl, Elke

doi:10.1007/s00390-009-0061-0

Cited by 23 publications

(19 citation statements)

References 22 publications

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“…Chaiwat 2010 [ 79 ], Kollef 1997 [ 80 ], Ely 1996 [ 81 ], Krishnan 2004 [ 82 ], Marelich 2000 [ 83 ], Namen 2001 [ 84 ], Navalesi 2008 [ 85 ], Piotto 2011 [ 86 ], Roh 2012 [ 87 ], Rose 2008 [ 88 ], Simeone 2002 [ 89 ], Stahl 2009 [ 90 ]…”

Section: Resultsmentioning

confidence: 99%

The clinical practice guideline for the management of ARDS in Japan

et al. 2017

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BackgroundThe Japanese Society of Respiratory Care Medicine and the Japanese Society of Intensive Care Medicine provide here a clinical practice guideline for the management of adult patients with ARDS in the ICU.MethodThe guideline was developed applying the GRADE system for performing robust systematic reviews with plausible recommendations. The guideline consists of 13 clinical questions mainly regarding ventilator settings and drug therapies (the last question includes 11 medications that are not approved for clinical use in Japan).ResultsThe recommendations for adult patients with ARDS include: we suggest against early tracheostomy (GRADE 2C), we suggest using NPPV for early respiratory management (GRADE 2C), we recommend the use of low tidal volumes at 6-8 mL/kg (GRADE 1B), we suggest setting the plateau pressure at 30cmH20 or less (GRADE2B), we suggest using PEEP within the range of plateau pressures less than or equal to 30cmH2O, without compromising hemodynamics (Grade 2B), and using higher PEEP levels in patients with moderate to severe ARDS (Grade 2B), we suggest using protocolized methods for liberation from mechanical ventilation (Grade 2D), we suggest prone positioning especially in patients with moderate to severe respiratory dysfunction (GRADE 2C), we suggest against the use of high frequency oscillation (GRADE 2C), we suggest the use of neuromuscular blocking agents in patients requiring mechanical ventilation under certain circumstances (GRADE 2B), we suggest fluid restriction in the management of ARDS (GRADE 2A), we do not suggest the use of neutrophil elastase inhibitors (GRADE 2D), we suggest the administration of steroids, equivalent to methylprednisolone 1-2mg/kg/ day (GRADE 2A), and we do not recommend other medications for the treatment of adult patients with ARDS (GRADE1B; inhaled/intravenous β2 stimulants, prostaglandin E1, activated protein C, ketoconazole, and lisofylline, GRADE 1C; inhaled nitric oxide, GRADE 1D; surfactant, GRADE 2B; granulocyte macrophage colony-stimulating factor, N-acetylcysteine, GRADE 2C; Statin.)ConclusionsThis article was translated from the Japanese version originally published as the ARDS clinical practice guidelines 2016 by the committee of ARDS clinical practice guideline (Tokyo, 2016, 293p, available from http://www.jsicm.org/ARDSGL/ARDSGL2016.pdf). The original article, written for Japanese healthcare providers, provides points of view that are different from those in other countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s40560-017-0222-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

The clinical practice guideline for the management of ARDS in Japan

et al. 2017

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“…De acordo com alguns estudos pode-se observar que há variações nos valores de PaO 2 e FiO 2 que são considerados para o desmame da ventilação mecânica. Assim como o nível de Ph e PaCO 2 [10][11][12][13] .…”

Section: Discussionunclassified

Critérios associados ao sucesso e insucesso do desmame da ventilação mecânica

Gulini

2016

Fisioter Bras

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ResumoIntrodução: Desmame é o processo de transição da ventilação artificial para a espontânea nos pacientes em ventilação mecânica invasiva por tempo superior a 24 h. Objetivo: Descrever os critérios clínicos, preditivos e fisiológicos associados com o sucesso e insucesso do desmame da ventilação mecânica invasiva. Método: Estudo descritivo retrospectivo, com análise de 53 prontuários de pacientes que realizaram o processo de desmame da ventilação mecânica, divididos em grupos sucesso (43) e insucesso (10). Resultados: Critérios clínicos (9%/60% sem reversão causa, 9%/60% sem neurológico adequado, 42%/20% BH+); critérios fisiológicos (pH 7,4/7,4, PCO2 39,9/33,1, BIC 19,4/18,6, PaO2 117,9/132,4, FiO2 0,4/0,4, PEEP 6,6/6, PaO2/FiO2 303,4/339), critérios preditivos (VC 526,3/584/, FR 18/18,4), modalidade desmame Tubo T (21%/50%) PS (79%/50%), tempo em ventilação mecânica em horas (167,1/218,4). Os dados são expressos em grupo sucesso/ insucesso respectivamente. Conclusão: Apesar de serem preenchidos os critérios clínicos, fisiológicos e preditivos, os pacientes podem evoluir com insucesso do desmame e necessitarem de reintubação, ou seja, os critérios para predizer o desmame são pontos relevantes para serem considerados antes da extubação, porém a avaliação clínica a beira do leito do paciente também deve ser analisada.Palavras-chave: desmame do respirador, respiração artificial, critérios preditivos. AbstractIntroduction: Weaning is the process of transition to spontaneous ventilation in patients undergoing invasive mechanical ventilation for more than 24 h. Objective: To describe the clinical, physiological and predictive criteria associated with success and failure of weaning from mechanical ventilation. Methods: Retrospective descriptive study, with analysis of records of 53 patients who underwent the process of weaning from mechanical ventilation and divided into groups success (43) and failure (10). Results: Clinical criteria (9%/60% without reversal concerned, 9%/60% without appropriate neurological, 42%/20% BH +); physiological criteria (pH 7.4/7.

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“…The results of this study show that total invasive mechanical ventilation times were similar for both weaning modes; average mechanical ventilation duration was approximately 4 days in both weaning modes, a shorter time than previously reported values [ 8 , 9 ]. In a recent meta-analysis, authors reported pooled data of 7 trials involving 520 participants and showed a significant reduction in total duration of mechanical ventilation of 1.8 days favoring SmartCare™ (MD: −1.68 days; 95 % CI: −3.33 to −0.03; p =0.05) with substantial heterogeneity ( I 2 =53 %; p =0.05) [ 11 , 17 – 21 ]. The mean mechanical ventilation time (pooled data from 7 studies, 520 participants [ 11 – 17 , 21 ]) was 8.34 (5.88) days for SmartCare™ versus 10.48 (8.25) days for non-automated weaning, showing that the condition of the patients in these seven polled studies was more severe than that of the patients in the present study.…”

Section: Discussionmentioning

confidence: 99%

Smart Care™ versus respiratory physiotherapy–driven manual weaning for critically ill adult patients: a randomized controlled trial

et al. 2015

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IntroductionA recent meta-analysis showed that weaning with SmartCare™ (Dräger, Lübeck, Germany) significantly decreased weaning time in critically ill patients. However, its utility compared with respiratory physiotherapist–protocolized weaning is still a matter of debate. We hypothesized that weaning with SmartCare™ would be as effective as respiratory physiotherapy–driven weaning in critically ill patients.MethodsAdult critically ill patients mechanically ventilated for more than 24 hours in the adult intensive care unit of the Albert Einstein Hospital, São Paulo, Brazil, were randomly assigned to be weaned either by progressive discontinuation of pressure support ventilation (PSV) with SmartCare™. Demographic data, respiratory function parameters, level of PSV, tidal volume (VT), positive end-expiratory pressure (PEEP), inspired oxygen fraction (FiO2), peripheral oxygen saturation (SpO2), end-tidal carbon dioxide concentration (EtCO2) and airway occlusion pressure at 0.1 second (P0.1) were recorded at the beginning of the weaning process and before extubation. Mechanical ventilation time, weaning duration and rate of extubation failure were compared.ResultsSeventy patients were enrolled 35 in each group. There was no difference between the two groups concerning age, sex or diagnosis at study entry. There was no difference in maximal inspiratory pressure, maximal expiratory pressure, forced vital capacity or rapid shallow breathing index at the beginning of the weaning trial. PEEP, VT, FiO2, SpO2, respiratory rate, EtCO2 and P0.1 were similar between the two groups, but PSV was not (median: 8 vs. 10 cmH2O; p =0.007). When the patients were ready for extubation, PSV (8 vs. 5 cmH2O; p =0.015) and PEEP (8 vs. 5 cmH2O; p <0.001) were significantly higher in the respiratory physiotherapy–driven weaning group. Total duration of mechanical ventilation (3.5 [2.0–7.3] days vs. 4.1 [2.7-7.1] days; p =0.467) and extubation failure (2 vs. 2; p =1.00) were similar between the two groups. Weaning duration was shorter in the respiratory physiotherapy–driven weaning group (60 [50–80] minutes vs. 110 [80–130] minutes; p <0.001).ConclusionA respiratory physiotherapy–driven weaning protocol can decrease weaning time compared with an automatic system, as it takes into account individual weaning difficulties.Trial registrationClinicaltrials.gov Identifier: NCT02122016. Date of Registration: 27 August 2013.

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Comparison of automated protocol-based versus non-protocol-based physician-directed weaning from mechanical ventilation

Cited by 23 publications

References 22 publications

The clinical practice guideline for the management of ARDS in Japan

The clinical practice guideline for the management of ARDS in Japan

Critérios associados ao sucesso e insucesso do desmame da ventilação mecânica

Smart Care™ versus respiratory physiotherapy–driven manual weaning for critically ill adult patients: a randomized controlled trial

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