First trial of computerized decision support tool reduces time on ventilator for children with lung failure

A group of Children’s Hospital Los Angeles researchers found that ventilation managed by a computerized decision support (CDS) tool shortened the time children with lung failure spent on ventilation and helped them regain the ability to breathe unassisted after mechanical support. The results were published in NEJM-Evidence.

“This is the first trial in either adults or children to test a computerized ventilation strategy that we had theorized could help preserve lung function and respiratory strength in children,” says Robinder Khemani, MD, MSCI, Vice Chair of Research, Department of Anesthesiology Critical Care Medicine at CHLA and lead author of the study. “We saw that using CDS, which recommends changes to ventilator settings to stay in a target range, resulted in children getting off the ventilator sooner than the children who received usual ventilator management directed by their physicians, without the help of a CDS tool."

In the 7-year Phase II study, 248 children with pediatric acute respiratory distress syndrome (PARDS) were randomized to either mechanical ventilation delivered by a lung and diaphragm-protective CDS tool or to the usual standard of care. The intervention patients had shorter weaning from ventilation—a median of 0.09 days compared to 1.04 days for patients in the control group. The interventional group also appeared to retain more respiratory muscle strength at the first standardized spontaneous breathing trial and appeared to have better functional status at ICU discharge than the control group.

“When these children left the intensive care unit, they seemed less debilitated than the children who received usual care,” says Dr. Khemani. “It may mean that they had fewer negative effects caused by the ventilator with this approach.” However, both groups showed similar respiratory strength by the time of hospital discharge, he noted.

Calibrating ventilation support to patient needs

CDS recommends frequent adjustments to ventilator settings according to shifting patterns in patients’ breathing to stay within recommended ranges. “It is very complex to execute a mechanical ventilation lung and diaphragm protection strategy like this because it requires balancing competing risks and making individualized decisions for patients,” says Dr. Khemani. "The real advantage of computer decision support is that it allows you to do this in a reproducible way.”