Abstract
IntroductionAutomated weaning systems may improve adaptation of mechanical support for a patient’s ventilatory needs and facilitate systematic and early recognition of their ability to breathe spontaneously and the potential for discontinuation of ventilation. Our objective was to compare mechanical ventilator weaning duration for critically ill adults and children when managed with automated systems versus non-automated strategies. Secondary objectives were to determine differences in duration of ventilation, intensive care unit (ICU) and hospital length of stay (LOS), mortality, and adverse events.MethodsElectronic databases were searched to 30 September 2013 without language restrictions. We also searched conference proceedings; trial registration websites; and article reference lists. Two authors independently extracted data and assessed risk of bias. We combined data using random-effects modelling.ResultsWe identified 21 eligible trials totalling 1,676 participants. Pooled data from 16 trials indicated that automated systems reduced the geometric mean weaning duration by 30% (95% confidence interval (CI) 13% to 45%), with substantial heterogeneity (I2 = 87%, P <0.00001). Reduced weaning duration was found with mixed or medical ICU populations (42%, 95% CI 10% to 63%) and Smartcare/PS™ (28%, 95% CI 7% to 49%) but not with surgical populations or using other systems. Automated systems reduced ventilation duration with no heterogeneity (10%, 95% CI 3% to 16%) and ICU LOS (8%, 95% CI 0% to 15%). There was no strong evidence of effect on mortality, hospital LOS, reintubation, self-extubation and non-invasive ventilation following extubation. Automated systems reduced prolonged mechanical ventilation and tracheostomy. Overall quality of evidence was high.ConclusionsAutomated systems may reduce weaning and ventilation duration and ICU stay. Due to substantial trial heterogeneity an adequately powered, high quality, multi-centre randomized controlled trial is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0755-6) contains supplementary material, which is available to authorized users.
Highlights
Automated weaning systems may improve adaptation of mechanical support for a patient’s ventilatory needs and facilitate systematic and early recognition of their ability to breathe spontaneously and the potential for discontinuation of ventilation
Through continuous monitoring and real-time interventions, automated systems theoretically provide improved adaptation of ventilatory support to patients’ needs when compared to cliniciandirected weaning [5]. Several such systems are commercially available and include Smartcare/PSTM (DrägerMedical, Lübeck, Germany), Adaptive Support Ventilation (ASV) (HamiltonMedical, Bonaduz, Switzerland), Automode (Siemens, Solna, Sweden), Proportional Assist Ventilation (PAV+ The University of Manitoba, Canada used under license by Covidien, Minneapolis, US), Mandatory Minute Ventilation (MMV) (Dräger Medical), Proportional Pressure Support (PPS) (DrägerMedical), Neurally Adjusted Ventilatory Assist (NAVA) (Maquet, Solna, Sweden) and Intellivent-ASV®(Hamilton Medical, Rhäzüns, Switzerland)
Most studies were of high methodological quality (Figure 2) no studies blinded participants or clinical personnel
Summary
Automated weaning systems may improve adaptation of mechanical support for a patient’s ventilatory needs and facilitate systematic and early recognition of their ability to breathe spontaneously and the potential for discontinuation of ventilation. Our objective was to compare mechanical ventilator weaning duration for critically ill adults and children when managed with automated systems versus non-automated strategies. Serious physiological and psychological sequelae are associated with protracted invasive mechanical ventilation, necessitating efficient processes to safely reduce and remove ventilator support, termed weaning [1,2] Tools such as weaning protocols and automated systems may facilitate systematic and early recognition of spontaneous. Through continuous monitoring and real-time interventions, automated systems theoretically provide improved adaptation of ventilatory support to patients’ needs when compared to cliniciandirected weaning [5]. More details regarding this review can be found in the Cochrane Database of Systematic Reviews [10]
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