• Dan Stieper Karbing, Savino Spadaro, Nilanjan Dey, Riccardo Ragazzi, Elisabetta Marangoni, Francesca Dalla Corte, Federico Moro, David Lodahl, Niklas Schurmann Hansen, Robert Winding, Stephen Edward Rees, and Carlo Alberto Volta.
• Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
• Crit. Care Med. 2018 Jul 1; 46 (7): e642-e648.

ObjectivesTo evaluate the physiologic effects of applying advice on mechanical ventilation by an open-loop, physiologic model-based clinical decision support system.DesignProspective, observational study.SettingUniversity and Regional Hospitals' ICUs.PatientsVaried adult ICU population.InterventionsAdvice were applied if accepted by physicians for a period of up to 4-8 hours.Measurements And Main ResultsSeventy-two patients were included for data analysis. Acceptance of advice was high with 95.7% of advice applied. In 41 patients in pressure support ventilation, following system advice led to significant decrease in PS, with PS reduced below 8 cm H2O in 15 patients (37%), a level not prohibiting extubation. Fraction of end-tidal CO2 values did not change, and increase in respiratory rate/VT was within clinical limits, indicating that in general, the system maintained appropriate patient breathing effort. In 31 patients in control mode ventilation, pressure control and tidal volume settings were decreased significantly, with tidal volume reduced below 8 mL/kg predicted body weight in nine patients (29%). Minute ventilation was maintained by a significant increase in respiratory rate. Significant reductions in FIO2 were seen on elevated baseline median values of 50% in both support and control mode-ventilated patients, causing clinically acceptable reductions in oxygen saturation.ConclusionsThe results indicate that during a short period, the clinical decision support system provided appropriate suggestions of mechanical ventilation in a varied ICU population, significantly reducing ventilation to levels which might be considered safe and beneficial.

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