Comparison of extubation times between protocolized versus automated weaning systems after major surgery

Background. Prolonged mechanical ventilation is associated with adverse clinical outcomes for critically ill patients. Objective. To assess the the extubation times of protocolised versus automated weaning systems in patients after major surgery in intensive care unit.  

Design. Retrospective analysis.

Measurements and results. We analyzed 70 patients with major abdominal or pelvic surgery. Patients that were used Draeger Evita2 Dura for weaning process named as the C (control) group (n=35) and patients that were used Draeger Evita2 XL Smartcare/PS named as the SC group (n=35). A physician evaluate the patient every 5 or 10 minutes in group C. Gender, age, weight, operation time, operation type, the total volume of intravenous infusion, bleeding, total dose of propofol, fentanyl citrate, rocuronium during surgery and extubation time were all recorded. All side effects included reintubation, bleeding, stroke, death, postoperative myocardial infarction were all recorded. The partial oxygen pressure (Pa02) and partial carbondioxide pressure (PaC02) were recorded before and after extubation.

Results. Demographic data and operative data were similar between groups (p>0.05). The extubation time was similar between groups (SC group versus C group: 191,14±79,1 min versus 188,29±51,47 min, p=0,534. There was significant decrease in arterial PO2 and increase in arterial PCO2 after extubation in all groups. No side effects were observed. Conclusion. In conclusion, although we found no differences between SmartCare and control groups, the evaluating of the patient increased the workload in the control group. We think that SmartCare decreased the workload. Thus, it can be recommended for weaning process of patients after major surgery in intensive care unit.

weaning, smartcare, pro-tocols

1. Esteban A, Alía I, Ibañez J, Benito S, Tobin MJ. Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest 1994;106:1188-93.

2. Esen S, Leblebicioglu H. Prevalence of nosocomial infections at intensive care units in Turkey: a multicentre 1-day point prevalence study. Scand J Infect Dis 2004;36:144-8.

3. Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998;129:433-40.

4. Dries DJ. Weaning from mechanical ventilation. J Trauma 1997;43:372-84.

5. Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, et al; Mechanical Ventilation International Study Group. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002;287:345-55.

6. Tonnelier JM, Prat G, Le Gal G, Gut-Gobert C, Renault A, Boles JM, et al. Impact of a nurses’ protocol-directed weaning procedure on outcomes in patients undergoing mechanical ventilation for longer than 48 hours: a prospective cohort study with a matched historical control group. Crit Care 2005;9:83-9.

7. Chaiwat O, Sarima N, Niyompanitpattana K, Komoltri C, Udomphorn Y, Kongsayreepong S. Protocol-directed vs. physician-directed wea-ning from ventilator in intra-abdominal surgical patients. J Med Assoc Thai 2010;93:930-6.

8. Kollef MH, Shapiro SD, Silver P, St John RE, Prentice D, Sauer S, et al. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 1997;25:567–74.

9. Rose L, Presneill JJ, Cade JF. Update in computer-driven weaning from mechanical ventilation. Anaesth Intensive Care 2007;35:213-21.

10. Burns K, Lellouche F, Lessard M. Automating the weaning process with advanced closed-loop systems. Intensive Care Med 2008;34:1757-65.

11. Lellouche F, Mancebo J, Jolliet P, Roeseler J, Schortgen F, Dojat M, et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med 2006;174:894–900.

12. Kataoka G, Murai N, Kodera K, Sasaki A, Asano R, Ikeda M, et al. Clinical experience with Smart Care after off-pump coronary artery bypass for early extubation J Artif Organs 2007;10(4):218-22.

13. Rose L, Presneill JJ, Johnston L, Cade JF. A randomized, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare/PS. Intensive Care Med 2008;34(10):1788-95.

14. Naritaka Y, Shimakawa T, Asaka S, Isohata N, Yamaguchi K, Murayama M, et al. Clinical experience with Smart Care for respiratory mana-gement after esophageal cancer surgery Ann Cancer Res Thera 2009;17:11-3.

15. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001;163:1256-76.

16. Ely EW, Bennett PA, Bowton DL, Murphy SM, Florance AM, Haponik EF. Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning. Am J Respir Crit Care Med 1999 Feb;159(2):439-46.

17. Burns KE, Meade MO, Lessard MR, Keenan SP, Lellouche F. Wean Earlier and Automatically with New technology (the WEAN study): a protocol of a multicentre, pilot randomized controlled trial. Trials 2009;10:81.

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

19. Dojat M, Brochard L. Knowledge based systems for automatic ventilatory management. Respir Care Clin N Am 2001;7(3):379-96.