Development and implementation of explicit computerized protocols for mechanical ventilation in children

Abstract

Mechanical ventilation can be perceived as a treatment with a very narrow therapeutic window, i.e., highly efficient but with considerable side effects if not used properly and in a timely manner. Protocols and guidelines have been designed to make mechanical ventilation safer and protective for the lung. However, variable effects and low compliance with use of written protocols have been reported repeatedly. Use of explicit computerized protocols for mechanical ventilation might very soon become a "must." Several closed loop systems are already on the market, and preliminary studies are showing promising results in providing patients with good quality ventilation and eventually weaning them faster from the ventilator. The present paper defines explicit computerized protocols for mechanical ventilation, describes how these protocols are designed, and reports the ones that are available on the market for children.

Figure 1

Schematic representation of the different processes for decision making. (A) Actual caregiver decision making. (B) Explicit computerized protocol in open-loop (clinical decision support systems). (C) Explicit computerized protocols in closed-loop.

Figure 2

The five components of a platform for development of an explicit computerized protocol (input data, controller, output data, graphic interface, virtual patient). The explicit computerized platform collects the data from the patient (SpO₂, ET_PCO2, ventilation data...) and processes the data to determine new ventilator settings in open- or closed-loop (output data). The virtual patient simulates the breathing pattern and the resulting blood gases for a mechanically ventilated patient with predefined characteristics (age, body weight, lung compliance, cardiac output, ventilator settings...). This virtual patient helps to test a large panel of clinical situations to validate the rules implemented and to detect any bugs.

Figure 3

Example of a platform for development of an explicit computerized protocol dedicated to the management of mechanical ventilation in children with acute lung injury that includes a virtual patient (named SimulResp) connected to a platform where rules are implemented (personal data).