[Comparison of computer-driven weaning and physician-directed weaning from mechanical ventilation: a randomized prospective study].

OBJECTIVE: To evaluate if the computer-driven weaning (CDW) with a closed-loop knowledge-based system introduced in a ventilator is superior to physician-directed weaning (PDW) in difficult-to-wean patients in the intensive care unit (ICU). METHODS: Sixty-two difficult-to-wean patients were randomized into 2 groups: weaning with Smart Care/PS (SC group, n = 32) or with synchronize intermittent mandatory ventilation add positive support ventilation (SP group, n = 30). In the SC group, the automated system titrated pressure support, conducted a spontaneous breathing trial and provided notification of success (separation potential). In the SP group, weaning from ventilators was carried out by gradually decreasing respiratory support. The length of mechanical ventilation and stay in ICU, the rate of ventilator-associated pneumonia (VAP), the retubing rate in 48 h, manual ventilator setting changes before extubation were compared between the 2 groups. RESULTS: In the SC group, the weaning time was (49 +/- 13) h, (67 +/- 37) h, and (254 +/- 96) h, respectively in patients with neuromuscular diseases, for post-operative respiratory support and patients with respiratory diseases; while in the SP group, the weaning time was (223 +/- 38) h, (106 +/- 34) h and (502 +/- 91) h, respectively; the difference between the 2 groups being statistically significant (chi(2) = 8.33, 4.77, 4.43, all P < 0.05). The time of stay in ICU was (9.0 +/- 1.7) d and (7.3 +/- 1.9) d in the SC group for patients with neuromuscular diseases and patients with post-operative respiratory support, respectively, while that was (20.8 +/- 5.1) d and (14.6 +/- 1.7) d in the SP group, respectively. Time of stay in ICU was significantly shorter in the SC group (chi2 = 6.74, 7.68, both P < 0.05). The number of manual ventilator setting changes was (5 +/- 1) times in the SC group, significantly less than that of the SP group (13 +/- 3, t = 2.73, P < 0.05). There were no significant differences between the SC and the SP groups in the rate of re-intubation, the rate of tracheotomy, the incidence of pneumothorax, the incidence of VAP and the incidence of subcutaneous emphysema. CONCLUSION: The CDW method used in patients with difficult weaning from ventilators was shown to shorten the weaning time, reduce stay in ICU, and decrease the need for manual adjustment of ventilators.