– Page 1 – Issue N°8 – December 2004
As published in IHE - October 2006
INTENSI VE CARE
Weaning system for mechanical ventilation in the ICU
When Stéphane Labrosse, Respiratory Therapist in-Charge at the Ottawa Hospital in Canada (General Campus, 2005), saw the chance to install a protocol-assisted weaning system that would benefit the hospital’s patients and help staff make
better use of their time, it did not take long before SmartCare/PS (Pressure Support), a knowledge-based weaning system for the management of mechanical
ventilation in intensive care, was being added to all of the hospital’s EvitaXL ventilators.
Ottawa Hospital
This is one of the leading academic health sciences centres in Canada. Spread over three
main campuses, its 10 000 staff members provide high-quality, patient-focused healthcare services in both English and French to more than 1.5 million people living in Ottawa
and Eastern Ontario. It provides specialty clinics for cancer, heart, kidney and vision care,
and conducts around 70 000 surgical procedures every year.
A case for knowledge-based weaning
Stéphane Labrosse and his colleagues had the opportunity to assess the knowledgebased weaning system’s benefits and appreciate its potential before the process of
implementation began. “We tried Dräger Medical’s SmartCare/PS on a few patients, had
good results and came to a rapid conclusion that it would be a great tool to have in our
ICU. Although some of my colleagues were already aware of the study conducted by Dr
Jolliet [1] in Geneva, which indicated that the time between starting and completing the
weaning process could be cut by up to 50%, what really excited them were the results
they generated in their own ICU in Ottawa,” says Labrosse. “Installing SmartCare/PS was
simply a matter of logic. Since 50% of our patients are in an active weaning stage on a
daily basis, we could see it would have a major impact on the way we worked.”
“We believe that the advantages of this tool will go beyond improving the efficiency of
weaning. We expect the workflow to improve as patients on the knowledge-based weaning protocol will need less monitoring, thus freeing up more time for the RTs to spend on
other patients. Practically, this will equate to them not being interrupted while treating a
trauma patient to attend to a patient in the next room who has gone into tachypnaea. With
SmartCare/PS in place, the machine will simply respond to the change in status and reset
the pressure support parameters accordingly. Furthermore, it will be easier to assess why
the patient was in distress, as the events and the trending will, in most cases, point
towards a conclusion. In addition, the monitoring and trending will give us a good indication of how the patients react to different situations, such as being given sedatives or
having a line inserted.”
Over the upcoming months, Labrosse aims to support the hospital’s decision to invest in
this new protocol-driven software by completing a clinical study. Improvements in
patient care and staff workflow will, he admits, be hard to quantify since they will not be
comparing SmartCare/PS against a specific weaning protocol. However, the early signs
are good.
Case study
Another reason for its rapid adoption was its wide applicability. In the Ottawa Hospital
ICU, it is anticipated that the new system will be used daily.Labrosse cites the case of a
67-year-old female patient who had undergone hip replacement surgery. Comorbid conditions were chronic obstructive pulmonary disease (COPD) and a resolved tracheostomy-associated pneumonia. The patient was ventilated on CPAP (pressure level = 8-cm
H2O, PEEP = 10-cm H2O), and failed extubation twice. Fifty-two days postoperatively,
she was still ventilated mechanically in the absence of other complications. Weaning
attempts failed daily. The patient’s respiratory rate, heart rate and blood pressure
became unstable, increasing whenever weaning attempts were made. It was decided to
place the patient on SmartCare/PS, continuing with the same ventilation parameters and
no other significant changes in treatment. The patient was monitored closely for comfort
and any changes in ventilatory support. The patient was very comfortable and vital signs
were stable, while pressure support decreased steadily. In less than 24 hours, the
patient was off the ventilator and on oxygen therapy via a tracheostomy hood. She was
transferred out of the ICU the following day.
“Although this is only one example,” says Labrosse, “we have had similar successes with
a number of patients and we are confident that the results of our trial will be as positive
as those of Dr Joliet’s, confirming that we have made the right decision to invest in
SmartCare/PS.”
Stephane Labrosse became a Respiratory Therapist at the Ottawa Hospital in 1996 and has always
had a special interest in intensive care ventilation. In addition to being a clinical instructor for Respiratory Therapy and Critical Care programmes at La Cité Collégiale, Ontario, Labrosse is also
involved with the teaching of resuscitation and crisis management techniques to medical residents, fellows and practicing physicians at The Ottawa Hospital.
1. Lellouche F, Mancebo J, Jolliet P. A Multicenter Randomized Trial of Computer-Driven Protocolized
Weaning from Mechanical Ventilation. Am. J. Respir. Crit. Care Med. 2006