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

Taniguchi, Corinne; Victor, Elivane S.; Pieri, Talita; Henn, R; Santana, Carolina Miller Mattos de; Giovanetti, Eleonora; Saghabi, Cilene; Timenetsky, Karina Tavares; Eid, Raquel Caserta; Silva, Eliezer; Matos, Gustavo Faissol Janot de; Schettino, Guilherme; Barbas, Carmen Sílvia Valente

doi:10.1186/s13054-015-0978-6

Cited by 28 publications

(38 citation statements)

References 26 publications

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“…Trials have demonstrated that application of protocols or guidelines for the weaning process may lead to a decrease in weaning time independent of the mode used, even better than automatic systems [ 46 , 47 ]. The ATS/CHEST guidelines suggest to use ventilator liberation protocols to manage adults mechanically ventilated for > 24 h [ 48 ].…”

Section: Main Textmentioning

confidence: 99%

The patient needing prolonged mechanical ventilation: a narrative review

Ambrosino

Vitacca

2018

Multidiscip Respir Med

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BackgroundProgress in management has improved hospital mortality of patients admitted to the intensive care units, but also the prevalence of those patients needing weaning from prolonged mechanical ventilation, and of ventilator assisted individuals. The result is a number of difficult clinical and organizational problems for patients, caregivers and health services, as well as high human and financial resources consumption, despite poor long-term outcomes. An effort should be made to improve the management of these patients. This narrative review summarizes the main concepts in this field.Main bodyThere is great variability in terminology and definitions of prolonged mechanical ventilation.There have been several recent developments in the field of prolonged weaning: ventilatory strategies, use of protocols, early mobilisation and physiotherapy, specialised weaning units.There are few published data on discharge home rates, need of home mechanical ventilation, or long-term survival of these patients.Whether artificial nutritional support improves the outcome for these chronic critically ill patients, is unclear and controversial how these data are reported on the optimal time of initiation of parenteral vs enteral nutrition.There is no consensus on time of tracheostomy or decannulation. Despite several individualized, non-comparative and non-validated decannulation protocols exist, universally accepted protocols are lacking as well as randomised controlled trials on this critical issue. End of life decisions should result from appropriate communication among professionals, patients and surrogates and national legislations should give clear indications.ConclusionPresent medical training of clinicians and locations like traditional intensive care units do not appear enough to face the dramatic problems posed by these patients. The solutions cannot be reserved to professionals but must involve also families and all other stakeholders. Large multicentric, multinational studies on several aspects of management are needed.

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Section: Main Textmentioning

confidence: 99%

The patient needing prolonged mechanical ventilation: a narrative review

Ambrosino

Vitacca

2018

Multidiscip Respir Med

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“…Recent advances in mechanical ventilation (NAVA, closed loop) were developed to facilitate weaning in acute care and in prolonged weaning [ 79 ]. Some recent meta-analysis [ 80 ] showed that weaning with closed-loop ventilators significantly decreased weaning time in critically ill patients, however, its utility when compared with respiratory physiotherapist protocolized weaning is still a matter of debate [ 81 ].…”

Section: Discussionmentioning

confidence: 99%

8th International conference on management and rehabilitation of chronic respiratory failure: the long summaries – Part 3

Ambrosino¹,

Casaburi

Chetta

et al. 2015

Multidiscip Respir Med

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This paper summarizes the Part 3 of the proceedings of the 8th International Conference on Management and Rehabilitation of Chronic Respiratory Failure, held in Pescara, Italy, on 7 and 8 May, 2015. It summarizes the contributions from numerous experts in the field of chronic respiratory disease and chronic respiratory failure. The outline follows the temporal sequence of presentations.This paper (Part 3) presents a section regarding Moving Across the Spectrum of Care for Long-Term Ventilation (Moving Across the Spectrum of Care for Long-Term Ventilation, New Indications for Non-Invasive Ventilation, Elective Ventilation in Respiratory Failure - Can you Prevent ICU Care in Patients with COPD?, Weaning in Long-Term Acute Care Hospitals in the United States, The Difficult-to-Wean Patient: Comprehensive management, Telemonitoring in Ventilator-Dependent Patients, Ethics and Palliative Care in Critically-Ill Respiratory Patients, and Ethics and Palliative Care in Ventilator-Dependent Patients).

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“…1 Another example are algorithms developed to facilitate and automatize the weaning process in pressure support ventilation based on patient spontaneous activity (respiratory rhythm, tidal volume) and expired CO 2 . 2,3 A third example are algorithms dedicated to control the airway pressure, called adaptive pressure-controlled mode (or dual mode) like AutoFlow ® (Dräger), VC+ (Puritan Bennett), APV (Hamilton Galileo). 4,5 All these algorithms respect a basic rule: the clinician is aware of their existence and can switch them off or on.…”

Section: Introductionmentioning

confidence: 99%

<p>When a Ventilator Takes Autonomous Decisions without Seeking Approbation nor Warning Clinicians: A Case Series</p>

Dufour¹,

Fadel²,

Gelée³

et al. 2020

IMCRJ

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Background: Complexity and functions of automated medical devices used to support life (eg, ventilators, dialysis machines, monitors, insulin pump with continuous blood glucose monitoring system, etc.) increase over time. Until recently, devices were partially automated by very simple feedback loops, with no or few software dependence (such as the simplest home thermostat). For the last two decades, devices have been increasingly driven by complex algorithms devoted to improve patient's treatment and monitoring as well as users experience. Methods: We report the unexpected and inappropriate operation of two recent ventilators, associated to potential harmful consequences. We provide both a description of the clinical situations (five ICU patients, archetypal situations) and a test bench analysis. Results: While set in volume mode, these ventilators activated an algorithm dedicated to limit airway pressure when an increase in airway resistance occurred. In such situations, a pressure-like mode was activated (with decelerating inspiratory flow and set pressure, with target of volume). The main consequences observed were that the tidal volume was no longer guaranteed or delivered and that the pressure limitation operated by the algorithm prevented the airway pressure from reaching the high-pressure alarm threshold. Conclusion: This led to the silent takeover of commands by the ventilator without clinicians or nurses being aware of it and without any warnings or alarms emission adapted to the severity of the event. Generally speaking, such an algorithm questions the place of automation and its limit when users are not aware of its presence as well as the need for regulation and additional tests before its implementation. Intensivists and respiratory care specialists should remain vigilant regarding the risk of rare but critical events related to unexpected functioning or insufficiently tested equipment during the pre-clinical development phases. They should not neglect misunderstood critical events without having performed sufficient investigations.

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

Cited by 28 publications

References 26 publications

The patient needing prolonged mechanical ventilation: a narrative review

The patient needing prolonged mechanical ventilation: a narrative review

8th International conference on management and rehabilitation of chronic respiratory failure: the long summaries – Part 3

<p>When a Ventilator Takes Autonomous Decisions without Seeking Approbation nor Warning Clinicians: A Case Series</p>

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