Weaning children from mechanical ventilation with a computer-driven system (closed-loop protocol): a pilot study

Abstract

Objective: To evaluate the applicability, tolerance, and efficacy of a closed-loop protocol to wean children from mechanical ventilation.

Design: Prospective single-center pilot study.

Setting: Tertiary care university hospital.

Patients: Twenty mechanically ventilated children aged between 1 and 17 yrs, with a body weight > or =10 kg, no inotropes, and no heavy sedation.

Interventions: Patients were weaned in pressure support mode by a closed-loop computerized protocol (closed-loop protocol) that interprets clinical data in real time and controls pressure support levels.

Measurements and main results: The closed-loop protocol applicability and tolerance were evaluated. The efficacy of this protocol was evaluated by comparing the duration of mechanical ventilation with a historical group of 20 patients weaned with a clinician-decision protocol. The closed-loop protocol successfully decreased pressure support ventilation in 16 children, recommended separation from the ventilator in 14 children, and did not cause any serious adverse events. Mechanical ventilation duration was 5.1 +/- 4.2 days in the closed-loop group and 6.7 +/- 11.5 days (mean +/- sd) in the clinician-decision group (p = .33) with no difference in the need for reintubation or noninvasive mechanical ventilation (one of 20 and four of 20, respectively; p = .20).

Conclusions: A closed-loop protocol was successfully used to wean children from mechanical ventilation. Further studies are required to assess the impact of this novel therapeutic strategy on the length of mechanical ventilation.