Key Point

A computerized system may reduce mechanical ventilation weaning time and length of ICU stay compared to a physician-controlled weaning process.

TEIL, FRANCE—Compared with a physician-controlled weaning process, a computerized system that "automatically drives the level of pressure support, automatically performs spontaneous breathing trials, and displays an incentive message when the trial is successfully passed" could reduce weaning duration from mechanical ventilation as well as shorten the length of ICU stay, according to François Lellouche, MD, and colleagues.¹

Dr. Lellouche, of the Hôpital Henri Mondor in Créteil, France, and colleagues randomized 144 patients enrolled from September 1, 2002, to July 12, 2003, to receive computer-driven weaning or usual care (physician-controlled weaning according to local guidelines). Weaning duration was reduced in the computer-driven group to a median of three days, compared with five days in the usual care group. Total duration of mechanical ventilation was similarly reduced—to 7.5 days in the computer-driven weaning group compared with 12 days in the usual care group. Computer-driven weaning also decreased median ICU stay from 15.5 to 12 days, compared with usual care, and caused no adverse events. The rate of reintubation within 72 hours after extubation in the computerized weaning group was 16.2%, compared to 23% in the usual care group, but this difference was not significant.

Dr. Lellouche and colleagues suggested that automation of the weaning protocol could explain the reduction in weaning duration from mechanical ventilation in patients using the computerized system. "The computer-driven weaning protocol does not depend on the willingness or availability of the staff, and full compliance with the weaning protocol is therefore ensured," stated the researchers. "A permanent evaluation and adjustment of ventilatory support cannot be continuously performed by caregivers, and the system has the ability to determine more easily and rapidly than usual care the time for a possible separation from the ventilator."

In addition, the investigators pointed out the likelihood that "the message delivered by the system also constitutes a strong incentive for the clinician to consider a possible extubation. This visual prompt constitutes an important aspect of the computer-driven protocol." The computerized system is also able to determine the setting by incorporating the breathing-pattern history of the patient and previous assistance level modifications.

Dr. Lellouche’s team noted several limitations to their study, such as the small percentage of eligible patients who were randomized (14%) and the fact that their study cohort did not receive blinded randomization, "which may have favored the computer-driven weaning group," they stated.

In an accompanying editorial, Gordon D. Rubenfeld, MD, MSc, of the Harborview Medical Center in Seattle, stated, "Some physicians may find computer-based protocols more acceptable than sharing responsibility with a respiratory therapist or a nurse. Computer-based protocols may be more effective, less expensive, or more reliable than implementation by non-physician clinicians. Hopefully, future studies of this technology will explore these questions with appropriate comparisons and measurements."²

—John Merriman

References
1. Lellouche F, Mancebo J, Jolliet P, et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med. 2006;174:894-900.
2. Rubenfeld GD. Just a spoonful of technology makes the protocol go down. Am J Respir Crit Care Med. 2006; 174:849-851.

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