Monday August 4, 2008
A randomized controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare/PS failed to show superiority for SmartCare/PS system

In a study by Lellouche published in 2006 AJRCCM (174;894-900) showed that SmartCare/PS was associated with a substantial reduction in the duration of ventilation and ICU length when compared to physician controlled weaning using local European guidelines.

SmartCare/PS monitors the patient’s respiratory status every 2 to 5 minutes (frequency, tidal volume, and end tidal CO2) and periodically adapts pressure support aiming for a safe efficient weaning process. The computerized SmartCare/PS establishes a respiratory status diagnosis, determines an intervention and then instructs the ventilator to decrease or increase the PS.

In a study by Louise Rose published in Intensive care Medicine they studied 102 patients.

• The median time from the first identified point of suitability for weaning to the state of separation potential using SmartCare/PS was 20 hrs as compared to 8hrs for the Control.
• The median time to successful extubation using SmartCare/PS was 43hrs as compared to 40 hrs with the Control.
• Study showed comparable rate of reintubation, tracheostomy, neuromuscular blockers usage and steroid use.

Conclusion: Substantial reductions in weaning duration with SmartCare/PS as previously demonstrated were not confirmed when compared to weaning managed by experienced critical care specialty nurses using 1:1 nurse to patient ratio. Majority of those nurses held a graduate critical care specialty qualification (Respiratory therapist are not employed in Australian context)



Reference:

Rose L, Presneill JJ, Johnston L, Cade JF. A randomized, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare/PS. Intensive Care Med 2008