Discover the product solutions Medtronic offers to Manage Weaning
The Vital Sync™ weaning readiness and spontaneous breathing trial (SBT) Monitoring application may allow clinicians to streamline and simplify the implementation of protocolized weaning. By continuously monitoring a configurable set of physiologic variables like RR, VT, VE, heart rate, and blood pressure, the Vital Sync™ weaning readiness feature alerts clinicians when patients demonstrate a readiness and tolerance for an SBT based on ACCP/AARC/SCCM guidelines.([FOOTNOTE=MacIntyre, N. R., Cook, D. J., Ely, E. W., Jr., et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001;120(6 Suppl):375S-395S.],[ANCHOR=],[LINK=])
Once clinicians initiate a spontaneous breathing trial, the Vital Sync™ SBT remote monitoring feature evaluates multiple patient parameters against the SBT protocol criteria.
Puritan Bennett™ ventilation systems are designed to promote more natural breathing and help improve patient comfort.([FOOTNOTE=Elganady, A. A., Beshey, B. N., & Abdelaziz, A. A. H. (Writer) (2014).],[ANCHOR=],[LINK=]) In doing so, Puritan Bennett™ ventilation systems help improve weaning success by improving patient-ventilator synchrony and reducing work of breathing.([FOOTNOTE=Grasso, S., Puntillo, F., Mascia, L., et al. Compensation for increase in respiratory workload during mechanical ventilation. Pressure-support versus proportional-assist ventilation. Am J Respir Crit Care Med. 2000;161(3 Pt 1):819-826.],[ANCHOR=],[LINK=]),([FOOTNOTE=Akoumianaki, E., Prinianakis, G., Kondili, E., Malliotakis, P., & Georgopoulos, D. Physiologic comparison of neurally adjusted ventilator assist, proportional assist and pressure support ventilation in critically ill patients. Respir Physiol Neurobiol. 2014;203:82-89.],[ANCHOR=],[LINK=]),([FOOTNOTE=Kondili, E., Prinianakis, G., Alexopoulou, C., Vakouti, E., Klimathianaki, M., & Georgopoulos, D. Respiratory load compensation during mechanical ventilation--proportional assist ventilation with load-adjustable gain factors versus pressure support. Intensive Care Med. 2006;32(5):692-699.],[ANCHOR=],[LINK=])
When patients are ventilated with Proportional Assist Ventilation Plus patient software (PAV+™ patient software), sedation is limited([FOOTNOTE=Georgopoulos, D., Xirouchaki, N., Tzanakis, N., & Younes, M. Driving pressure during assisted mechanical ventilation: Is it controlled by patient brain? Respir Physiol Neurobiol. 2016;228:69-75.],[ANCHOR=],[LINK=]) so the patient’s respiratory drive remains intact and neither driving pressure or VT are set by the caregiver.([FOOTNOTE=Wright, B. J. Lung-protective ventilation strategies and adjunctive treatments for the emergency medicine patient with acute respiratory failure. Emerg Med Clin North Am. 2014;32(4):871-887.],[ANCHOR=],[LINK=]) Instead, the patient’s intrinsic reflexes and instantaneous muscle activity control ventilation.7
Lung Protective VentilationLung protective ventilation, consisting of low tidal CO2 volumes, lower end-inspiratory airway pressures, and higher positive end-expiratory pressures, has been demonstrated to improve survival in patients with acute respiratory distress syndrome by reducing the mechanical stress on the lung associated with ventilator induced lung injury.([FOOTNOTE=Serpa Neto, A., Cardoso, S. O., Manetta, J. A., et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012;308(16):1651-1659.],[ANCHOR=],[LINK=])
However, Amato’s re-analysis of individual data from more than 3,500 ARDS patients who were enrolled in previous randomized control clinical studies investigating lung protective ventilation revealed that controlling changes in driving pressure (ratio of tidal volume to respiratory system compliance) rather than changes in tidal volume (Vt) or positive end expiratory pressure (PEEP) is more strongly associated with survival.([FOOTNOTE=Amato, M. B., Meade, M. O., Slutsky, A. S., et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747-755.],[ANCHOR=],[LINK=])
Achieving adequate gas exchange is a primary criterion for weaning eligibility.9 As gas exchange is dependent on the respiratory muscles being able to generate adequate force to deliver gas to the alveoli, facilitating patients for weaning readiness should focus on reducing the respiratory muscle loading that undermines respiratory muscle function via stress and fatigue.([FOOTNOTE=Gilstrap, D., & MacIntyre, N. Patient-ventilator interactions. Implications for clinical management. Am J Respir Crit Care Med. 2013;188(9):1058-1068.],[ANCHOR=],[LINK=])
Kondili et al.5 imposed artificial mechanical loads on 10 patients undergoing both pressure support and PAV+™ patient software in order to see the influence of ventilation mode on inspiratory effort (pressure time product at the diaphragm per liter). When undergoing PAV+™ ventilation, patients exhibited significantly less inspiratory effort under artificially imposed mechanical loads (P<0.05).
PAV+™ breath assist patient software allows patients to have total control over their breathing pattern.([FOOTNOTE=Costa, R., Spinazzola, G., Cipriani, F., et al. A physiologic comparison of proportional assist ventilation with load-adjustable gain factors (PAV+) versus pressure support ventilation (PSV). Intensive Care Med. 2011;37(9):1494-1500.],[ANCHOR=],[LINK=]) Instead of rigidly providing a target volume or pressure, PAV+™ patient software amplifies the patients’ inspiratory effort and removes a proportion of the breathing workload.3 In doing so, PAV+™ patient software reduces patient-ventilator asynchrony2 and sedative requirement([FOOTNOTE=Xirouchaki, N., Kondili, E., Klimathianaki, M., & Georgopoulos, D. Is proportional-assist ventilation with load-adjustable gain factors a user-friendly mode? Intensive Care Med. 2009;35(9):1599-1603],[ANCHOR=],[LINK=]) both of which are associated with increased time on ventilation.([FOOTNOTE=de Wit, M., Miller, K. B., Green, D. A., Ostman, H. E., Gennings, C., & Epstein, S. K. Ineffective triggering predicts increased duration of mechanical ventilation. Crit Care Med. 2009;37(10):2740-2745.],[ANCHOR=],[LINK=]),12
For more information on the feasibility of utilizing PAV+™ patient software to support patient weaning([FOOTNOTE=Carteaux, G., Mancebo, J., Mercat, A., et al. Bedside adjustment of proportional assist ventilation to target a predefined range of respiratory effort. Crit Care Med. 2013;41(9):2125-2132.],[ANCHOR=],[LINK=]) and reduce time on mechanical ventilation,2 see the study summaries by Carteaux et al.14 and El Ganady et al.2