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Published ahead of print on July 13, 2006, doi:10.1164/rccm.200511-1780OC

Am. J. Respir. Crit. Care Med., Volume 174, Number 8, October 2006, 894-900

A more recent version of this article appeared on October 15, 2006
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Submitted on November 21, 2005
Accepted on July 13, 2006

A Multicenter Randomized Trial of Computer-Driven Protocolized Weaning from Mechanical Ventilation

Francois Lellouche1, Jordi Mancebo2, Philippe Jolliet3, Jean Roeseler4, Frederique Schortgen5, Michel Dojat6, Belen Cabello2, Lila Bouadma5, Pablo Rodriguez1, Salvatore Maggiore7, Marc Reynaert4, Stefan Mersmann8, and Laurent Brochard1*

1 AP-HP, Reanimation Medicale, Hopital Henri Mondor, Paris, France, 2 Servei Medicina Intensiva, Hospital Sant Pau, Barcelona, Spain, 3 Soins Intensifs de Medecine, Hopital Cantonal Universitaire, Geneve, Switzerland, 4 Soins Intensifs - Unite medico-chirurgicale, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium, 5 AP-HP, Reanimation Medicale et Infectieuse, Hopital Bichat, Paris, France, 6 Neuro-imagerie Fonctionelle et Metabolique, INSERM / UJF U594, Grenoble, France, 7 Istituto di Anestesiologia e Rianimazione, Universita Cattolica Policlinico A. Gemelli, Rome, Italy, 8 Research & Development Critical Care, Draeger Medical AG & Co. KG, Lubeck, Germany

* To whom correspondence should be addressed. E-mail: laurent.brochard{at}hmn.aphp.fr.

Rationale and objectives: Duration of weaning from mechanical ventilation may be reduced by the use of a systematic approach. We assessed whether a closed-loop knowledge-based algorithm introduced in a ventilator to act as a computer-driven weaning protocol can improve patient outcomes as compared to usual care. Methods and measurements: We conducted a multicenter randomized controlled study with concealed allocation to compare usual care for weaning to computer-driven weaning. The computerized protocol included an automatic gradual reduction in pressure support, automatic performance of spontaneous breathing trials (SBT), and generation of an incentive message when a SBT was successfully passed. One hundred forty-four patients were enrolled before weaning initiation. They were randomly allocated to computer-driven weaning or to physician-controlled weaning according to local guidelines. Weaning duration until successful extubation and total duration of ventilation were the primary endpoints. Main results: Weaning duration was reduced in the computer-driven group from a median of 5 to 3 days (P=0.01) and total duration of mechanical ventilation from 12 to 7.5 days (P=0.003). Reintubation rate did not differ (23 vs 16 %, P=0.40). Computer-driven weaning also decreased median intensive-care-unit stay duration from 15.5 to 12 days (P=0.02) and caused no adverse events. The amount of sedation did not differ between groups. In the usual care group compliance to recommended modes and to SBT was estimated respectively at 96% and 51%. Conclusions: The specific computer-driven system used in this study can reduce mechanical ventilation duration and intensive-care-unit length of stay, as compared to physician-controlled weaning process.
Key words: mechanical ventilation, weaning protocols, computers, knowledge-based system, extubation




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