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Decision support system facilitates rapid decreases in pressure support and appropriate inspiratory muscle workloads in adults with respiratory failure.
- Source :
-
Journal of critical care [J Crit Care] 2017 Dec; Vol. 42, pp. 213-217. Date of Electronic Publication: 2017 Jul 28. - Publication Year :
- 2017
-
Abstract
- Purpose: A commercially available decision support system (DSS) provides guidance for setting inspiratory pressure support (PS) to maintain work of breathing (WOB/min), breathing frequency (f), and tidal volume (V <subscript>T</subscript> ) in proper clinical ranges (VentAssistâ„¢). If these values are outside the proper clinical range patients may suffer fatigue, atrophy, hypoventilation, hyperventilation, volutrauma, or V <subscript>T</subscript> deficiency. The purpose of our study was to evaluate the increase of the percentage of breaths in the targeted clinical ranges when the DSS guidance for setting the PS was followed.<br />Materials and Methods: The study included 43 intubated adults with respiratory failure in an academic medical intensive care unit. Each of the patients had received ventilatory support for >24h with no weaning trials attempted. Clinicians switched the ventilator to PS then proceeded to utilize the guidance recommended by the DSS for setting PS for 21 patients (intervention group); while the clinicians caring for the remaining 23 patients did not have access to the DSS (control group).<br />Results: The use of a DSS to set PS level increased the percentage of breaths in the targeted clinical range [28% to 48%, p value<0.0001]. An unexpected result was that while following the DSS 18 of the 21 patients were rapidly weaned to minimal ventilator settings within 46±38min; however, when the DSS was not available weaning to minimal ventilator settings lasted 21±12h [p value<0.0001].<br />Conclusions: The DSS is successful at assisting clinicians on how to set PS specific to a patient's individual demands (V <subscript>T</subscript> and f) while accounting for their breathing effort (WOB/min). The DSS appears to promote rapid weaning of PS to minimal ventilator settings when appropriate.<br /> (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Female
Humans
Male
Middle Aged
Physical Therapy Modalities
Positive-Pressure Respiration methods
Pulmonary Disease, Chronic Obstructive physiopathology
Pulmonary Disease, Chronic Obstructive therapy
Respiration
Respiratory Insufficiency therapy
Software
Tidal Volume physiology
Ventilator Weaning methods
Ventilators, Mechanical
Work of Breathing physiology
Respiratory Insufficiency physiopathology
Respiratory Muscles physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1557-8615
- Volume :
- 42
- Database :
- MEDLINE
- Journal :
- Journal of critical care
- Publication Type :
- Academic Journal
- Accession number :
- 28779703
- Full Text :
- https://doi.org/10.1016/j.jcrc.2017.07.047