Comparison of 3 modes of automated weaning from mechanical ventilation: A bench study

Author(s)

Morato, Jose B. ^[1] ; Sakuma, Mayara T. A. ^[1] ; Ferreira, Juliana C. ^{[1, 2]} ; Caruso, Pedro ^{[1, 2]}

Affiliation

^[1] Univ Sao Paulo, Sch Med, Heart Inst Incor, Resp ICU, Pulm Dept, Sao Paulo - Brazil

^[2] UTI Hosp AC Camargo, Sao Paulo - Brazil

• Document type: Journal article
• Source: JOURNAL OF CRITICAL CARE; v. 27, n. 6 DEC 2012.
• Web of Science Citations: 6

Abstract

Purpose: Automated weaning modes are available in some mechanical ventilators, but no studies compared them hitherto. We compared the performance of 3 automated modes under standard and challenging situations. Methods: We used a lung simulator to compare 3 automated modes, adaptive support ventilation (ASV), mandatory rate ventilation (MRV), and Smartcare, in 6 situations, weaning success, weaning failure, weaning success with extreme anxiety, weaning success with Cheyne-Stokes, weaning success with irregular breathing, and weaning failure with ineffective efforts. Results: The 3 modes correctly recognized the situations of weaning success and failure, even when anxiety or irregular breathing were present but incorrectly recognized weaning success with Cheyne-Stokes. MRV incorrectly recognized weaning failure with ineffective efforts. Time to pressure support (PS) stabilization was shorter for ASV (1-2 minutes for all situations) and MRV (1-7 minutes) than for Smartcare (8-78 minutes). ASV had higher rates of PS oscillations per 5 minutes (4-15), compared with Smartcare (0-1) and MRV (0-12), except when extreme anxiety was present. Conclusions: Smartcare, ASV, and MRV were equally able to recognize weaning success and failure, despite the presence of anxiety or irregular breathing but performed incorrectly in the presence of Cheyne-Stokes. PS behavior over the time differs among modes, with ASV showing larger and more frequent PS oscillations over the time. Clinical studies are needed to confirm our results. (C) 2012 Elsevier Inc. All rights reserved. (AU)

• FAPESP's process: 10/11545-0 - Evaluation of a automatized mechanical ventilation weaning mode(SmartCare®):a bench study
• Grantee: Mayara Tiemi Ayres Sakuma
• Support Opportunities: Scholarships in Brazil - Scientific Initiation