Abstract
Purpose: To assess whether a clinical decision support system (CDSS) suggests PS and FIO2 maintaining appropriate breathing effort, and minimizing FIO2. Materials: Prospective, cross-over study in PS ventilated ICU patients. Over support (150% baseline) and under support (50% baseline) were applied by changing PS (15 patients) or PEEP (8 patients). CDSS advice was followed. Tension time index of inspiratory muscles (TTies), respiratory and metabolic variables were measured. Results: PS over support (median 8.0 to 12.0 cmH2O) reduced respiratory muscle activity (TTies 0.090 ± 0.028 to 0.049 ± 0.030; p <.01), and tended to increase tidal volume (VT: 8.6 ± 3.0 to 10.1 ± 2.9 ml/kg; p =.08). CDSS advice reduced PS (6.0 cmH2O, p =.005), increased TTies (0.076 ± 0.038, p <.01), and tended to reduce VT (8.9 ± 2.4 ml/kg, p =.08). PS under support (12.0 to 4.0 cmH2O) slightly increased respiratory muscle activity, (TTies to 0.120 ± 0.044; p =.007) with no significant CDSS advice. CDSS advice reduced FIO2 by 12–14% (p =.005), resulting in median SpO2 = 96% (p <.02). PEEP changes did not result in changes in physiological variables, or CDSS advice. Conclusion: The CDSS advised on low values of PS often not prohibiting extubation, while acting to preserve respiratory muscle function and preventing passive lung inflation. CDSS advice minimized FIO2 maintaining SpO2 at safe and beneficial values.
| Original language | English |
|---|---|
| Pages (from-to) | 407-413 |
| Number of pages | 7 |
| Journal | Journal of Critical Care |
| Volume | 48 |
| DOIs | |
| Publication status | Published - Dec 1 2018 |
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Keywords
- Clinical decision support
- Esophageal pressure
- Mechanical ventilation
- Physiological models
- Pressure support
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
Cite this
An open-loop, physiological model based decision support system can reduce pressure support while acting to preserve respiratory muscle function. / Spadaro, Savino; Karbing, Dan Stieper; Dalla Corte, Francesca; Mauri, Tommaso; Moro, Federico; Gioia, Antonio; Volta, Carlo Alberto; Rees, Stephen Edward.
In: Journal of Critical Care, Vol. 48, 01.12.2018, p. 407-413.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - An open-loop, physiological model based decision support system can reduce pressure support while acting to preserve respiratory muscle function
AU - Spadaro, Savino
AU - Karbing, Dan Stieper
AU - Dalla Corte, Francesca
AU - Mauri, Tommaso
AU - Moro, Federico
AU - Gioia, Antonio
AU - Volta, Carlo Alberto
AU - Rees, Stephen Edward
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Purpose: To assess whether a clinical decision support system (CDSS) suggests PS and FIO2 maintaining appropriate breathing effort, and minimizing FIO2. Materials: Prospective, cross-over study in PS ventilated ICU patients. Over support (150% baseline) and under support (50% baseline) were applied by changing PS (15 patients) or PEEP (8 patients). CDSS advice was followed. Tension time index of inspiratory muscles (TTies), respiratory and metabolic variables were measured. Results: PS over support (median 8.0 to 12.0 cmH2O) reduced respiratory muscle activity (TTies 0.090 ± 0.028 to 0.049 ± 0.030; p <.01), and tended to increase tidal volume (VT: 8.6 ± 3.0 to 10.1 ± 2.9 ml/kg; p =.08). CDSS advice reduced PS (6.0 cmH2O, p =.005), increased TTies (0.076 ± 0.038, p <.01), and tended to reduce VT (8.9 ± 2.4 ml/kg, p =.08). PS under support (12.0 to 4.0 cmH2O) slightly increased respiratory muscle activity, (TTies to 0.120 ± 0.044; p =.007) with no significant CDSS advice. CDSS advice reduced FIO2 by 12–14% (p =.005), resulting in median SpO2 = 96% (p <.02). PEEP changes did not result in changes in physiological variables, or CDSS advice. Conclusion: The CDSS advised on low values of PS often not prohibiting extubation, while acting to preserve respiratory muscle function and preventing passive lung inflation. CDSS advice minimized FIO2 maintaining SpO2 at safe and beneficial values.
AB - Purpose: To assess whether a clinical decision support system (CDSS) suggests PS and FIO2 maintaining appropriate breathing effort, and minimizing FIO2. Materials: Prospective, cross-over study in PS ventilated ICU patients. Over support (150% baseline) and under support (50% baseline) were applied by changing PS (15 patients) or PEEP (8 patients). CDSS advice was followed. Tension time index of inspiratory muscles (TTies), respiratory and metabolic variables were measured. Results: PS over support (median 8.0 to 12.0 cmH2O) reduced respiratory muscle activity (TTies 0.090 ± 0.028 to 0.049 ± 0.030; p <.01), and tended to increase tidal volume (VT: 8.6 ± 3.0 to 10.1 ± 2.9 ml/kg; p =.08). CDSS advice reduced PS (6.0 cmH2O, p =.005), increased TTies (0.076 ± 0.038, p <.01), and tended to reduce VT (8.9 ± 2.4 ml/kg, p =.08). PS under support (12.0 to 4.0 cmH2O) slightly increased respiratory muscle activity, (TTies to 0.120 ± 0.044; p =.007) with no significant CDSS advice. CDSS advice reduced FIO2 by 12–14% (p =.005), resulting in median SpO2 = 96% (p <.02). PEEP changes did not result in changes in physiological variables, or CDSS advice. Conclusion: The CDSS advised on low values of PS often not prohibiting extubation, while acting to preserve respiratory muscle function and preventing passive lung inflation. CDSS advice minimized FIO2 maintaining SpO2 at safe and beneficial values.
KW - Clinical decision support
KW - Esophageal pressure
KW - Mechanical ventilation
KW - Physiological models
KW - Pressure support
UR - http://www.scopus.com/inward/record.url?scp=85054824304&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85054824304&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2018.10.003
DO - 10.1016/j.jcrc.2018.10.003
M3 - Article
AN - SCOPUS:85054824304
VL - 48
SP - 407
EP - 413
JO - Journal of Critical Care
JF - Journal of Critical Care
SN - 0883-9441
ER -