Automating the weaning process with advanced closed-loop systems

Byline: Karen E. A. Burns (1,2), Francois Lellouche (3), Martin R. Lessard (4) Abstract: Background Limiting the duration of invasive ventilation is an important goal in caring for critically ill patients. Several clinical trials have shown that compared to traditional care, protocols can reduce the total duration of mechanical ventilation. Computerized or automated weaning has the potential to improve weaning, while decreasing associated workload, and to transfer best evidence into clinical practice by integrating closed-loop technology into protocols that can be operationalized continuously. Discussion In this article, we review the principles of automated systems, discuss automated systems that can be used during weaning, and examine the best-current evidence from randomized trials and observational studies supporting their use. We highlight three commercially available systems (Mandatory Minute Ventilation, Adaptive Support Ventilation and SmartCare[TM]) that can be used to automate the weaning process. We note advantages and disadvantages associated with individual weaning systems and differences among them. Conclusions We discuss the potential role for automation in complimenting clinical acumen, reducing practice pattern variation and facilitating knowledge translation into clinical practice, and underscore the need for additional high quality investigations to evaluate automated weaning systems in different practice settings and diverse patient populations. Author Affiliation: (1) Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada (2) Keenan Research Centre, Li Ka Shing Knowledge Institute, R. Samuel McLaughlin Foundation, St Michael's Hospital, the University of Toronto, 30 Bond Street, Room 4-045 Queen Wing, Toronto, ON, M5B 1W8, Canada (3) Department of Critical Care, Centre de recherche de l'Hopital Laval, Institut Universitaire de Cardiologie et de Pneumologie, Universite LAVAL, Quebec City, QC, Canada (4) Departments of Anesthesia and Critical Care, Hopital de l'Enfant-Jesus, Universite Laval, Quebec City, QC, Canada Article History: Registration Date: 08/05/2008 Received Date: 04/02/2008 Accepted Date: 04/05/2008 Online Date: 03/06/2008 Article note: Dr. Burns holds a Clinician Scientist award from the Canadian Institutes of Health Research. Dr. Burns and Dr. Lellouche hold a travel bursary from Draeger Medical Inc.