Computerized protocol for weaning patients from mechanical ventilation using pressure support

An explicitly defined, open-loop computerized protocol to wean patients from mechanical ventilatory support using the pressure support mode was developed and tested. The logic in the protocol was refined through review of the literature, consensus of experts, computer simulation, bedside testing. An initial protocol in which the pressure support level was adjusted based upon a respiratory rate threshold was tested in five patients using paper glow diagrams. Users found the paper protocol difficult to follow and compliance was poor. Transient tachypnea prevented efficient weaning. All patients were removed from the protocol be extubation. A modification of the rapid shallow breathing test was used as the threshold variable upon which to adjust the level of pressure support. This logic was computerized and tested in 10 patients for a total of 1075 hours. The compliance rate with the 1394 instructions generated by the protocol was 95%, and 96% of the instructions were correct. Development of this protocol had many benefits beyond the generation of an explicit set of rules for weaning patient s for mechanical ventilation. Protocol development requires that all variables be scrutinized for accuracy, reliability, and fairness of measurement. This enforced standardization of data elements improves reproducibility. User acceptance of protocols is enhanced by integration into the normal workflow, rapid response to and correction of problem during protocol application, and by giving users feedback on patient progress