Chinese Society of Critical Care Medicine-CSCCM 10th Anniversary

讲座摘要

自动化脱机 Automated weaning

Laurent Brochard

讲座课件

Address correspondence to

Pr Laurent Brochard

Service de réanimation médicale, Hôpital Henri Mondor

51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France

Tel: +33 1 49 81 23 84 Fax: +33 1 42 07 99 43

E-mail: laurent.brochard@hmn.aphp.fr

Abstract

Weaning is the process during which mechanical ventilation is gradually or abruptly withdrawn.

Weaning accounts for approximately 40% of the total time spent on mechanical ventilation, and up to 50% of the time in some specific population (i.e. COPD patients).

Recently, a new classification of weaning has been proposed¹ :

(i) simple weaning (one spontaneous breathing trial followed by a successful extubation)

(ii) difficult weaning (failure of the initial SBT, but successful extubation requiring up to three SBT within 7 days)

(iii) prolonged weaning (more than 3 failed SBTs or more than 7 days after the first SBT)

(table 1. For the majority of the patients, the process can be classified as simple, as 70- 80% of the patients passed the first weaning trial and can be extubated.)

Because the main problem is to detect the right time when the patient is ready to be extubated, a new promising area is the use of computerized-driven ventilators that enacts continuous automated management towards weaning.

Considering the shortage of clinicians that is planned and the increased number of patients on mechanical ventilation, this tool will probably take a major room in the near future.

The SmartCare system (initially called NeoGanesh) adjusts the pressure support level to maintain the patient in a “zone of respiratory comfort” and automatizes the weaning process^2,3.

Automatically conducted spontaneous breathing trials in pressure support performed within the Neoganesh system have shown to be accurate weaning in comparison with T-piece.

In a multicenter study this system was compared to usual weaning⁴.

Weaning duration and ICU stay were significantly reduced by 2 to 3 days.

In other, smaller studies the weaning time was similar but there was not adverse effects nor increased duration of ventilation.

These automated systems have a great potential to facilitate the management of mechanical ventilation and weaning.

References

Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T: Weaning from mechanical ventilation. Eur Respir J 2007; 29: 1033-56

Dojat M, Brochard L, Lemaire F, Harf A: A knowledge based systems for assisted ventilation of patients in intensive care units. Int J Clin Monit Comput 1992; 9: 239-250

Dojat M, Harf A, Touchard D, Laforest M, Lemaire F, Brochard L: Evaluation of a knowledge-based system providing ventilatory management and decision for extubation. Am J Respir Crit Care Med. 1996; 153: 997-1004

Lellouche F, Mancebo J, Jolliet P, Roeseler J, Schortgen F, Dojat M, Cabello B, Bouadma L, Rodriguez P, Maggiore S, Reynaert M, Mersmann S, Brochard L: A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med 2006; 174: 894-900

第二届中法危重病医学研讨会暨上海重症医学论坛（2009年12月中国上海）