Editorial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Respirol. Jul 28, 2016; 6(2): 49-53
Published online Jul 28, 2016. doi: 10.5320/wjr.v6.i2.49
Automated weaning from mechanical ventilation
Mirko Belliato
Mirko Belliato, Second ICU, S. C. Anestesia e Rianimazione 2, Foundation IRCCS Policlinico San Matteo, 27100 Pavia, Lombardia, Italy
Author contributions: Belliato M was solely responsible for the conception, design and writing of this Editorial.
Conflict-of-interest statement: Mirko Belliato received economic support and fees from Hamilton Medical AG, CH, for lectures, congresses and workshops on mechanical ventilation and respiratory support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mirko Belliato, MD, Specialist in Intensive and Emergency Care, Second ICU, S. C. Anestesia e Rianimazione 2, Foundation IRCCS Policlinico San Matteo, P. le Golgi n. 19, 27100 Pavia, Lombardia, Italy. m.belliato@smatteo.pv.it
Telephone: +39-03-82502769Fax: +39-03-82501026
Received: April 1, 2016
Peer-review started: April 6, 2016
First decision: May 17, 2016
Revised: May 30, 2016
Accepted: June 27, 2016
Article in press: June 29, 2016
Published online: July 28, 2016
Processing time: 108 Days and 10.9 Hours
Abstract

Mechanical ventilation (MV) is one of the lifesaving techniques applied to critically ill patients at bedside. However, some complications, such as ventilator-induced lung injury and ventilator-associated pneumonia, may occur in a patient undertaking MV and are often related to the duration of MV. Some written protocols have been proposed to reduce the risk of such complications, but they can be time consuming, leading to fluctuation in protocol implementation and compliance. Moreover, written instructions tend to be general and thus cannot cover all possible scenarios, resulting in variable interpretation of the protocol. To overcome these limiting factors, protocols have been computerized and there is convincing evidence in the literature showing that computerized protocols benefit management of the process and reduce the time a patient spends under MV. QuickWean is a computer-aided weaning protocol implemented on the Hamilton S1 ventilator (Hamilton Medical AG, Bonaduz, Switzerland), which guides the patient through the weaning process without requiring any intervention by the treating physician. The fully-automated ventilation mode is INTELLiVENT®-ASV (Hamilton Medical AG), which is set according to the patient’s respiratory mechanics, patient-ventilator interaction, peripheral oxygen saturation (SpO2) and pulmonary end-tidal carbon dioxide (PetCO2). The INTELLiVENT®-ASV mode sets automatically each minute to provide accurate ventilation, pressure support, fraction of inspired oxygen and positive end-expiratory pressure based on the patient’s needs. QuickWean can be pre-set to match the established weaning policy of an intensive care unit as well as being customized to a patient’s needs. It provides a progressive reduction of respiratory support, and guides the patient through the spontaneous breathing trial (SBT). At the end of the SBT, the ventilator re-starts the previous ventilation support and provides a report of the successful SBT. During all phases, PetCO2, SpO2 and all breathing parameters are monitored. This new automated weaning tool may improve the safety and effectiveness of an SBT, reducing the time spent in the process of weaning and providing a lower workload for the treating physician.

Keywords: Automated ventilation; Automated weaning; Weaning from artificial ventilation; Weaning protocol; QuickWean

Core tip: Weaning from mechanical ventilation is a crucial point during respiratory therapy and most intensive care units have developed human-based protocols to wean the patient. Newer ventilators have implemented a computer-aided weaning protocol, and the QuickWean application may be the most complete because it can drive the patient automatically from total passivity to readiness to wean. A key feature of the full computer-driven process is the safeness of the procedure, ensured by the patient always being under control in terms of peripheral oxygen saturation, pulmonary end-tidal carbon dioxide and respiratory fatigue, and improving upon the discontinuous human-driven process.