A KNOWLEDGE-BASED SYSTEM FOR ASSISTED VENTILATION OF PATIENTS IN INTENSIVE-CARE UNITS

被引：92

作者：

DOJAT, M

BROCHARD, L

LEMAIRE, F

HARF, A

机构：

[1] Institut National de la Santé et de la Recherche Médicale INSERM U 296, Hôpital Henri Mondor, Créteil

[2] Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil

[3] Département de Physiologie, Hôpital Henri Mondor, Créteil

来源：

INTERNATIONAL JOURNAL OF CLINICAL MONITORING AND COMPUTING | 1992年 / 9卷 / 04期

关键词：

ASSISTED VENTILATION; KNOWLEDGE-BASED SYSTEM; MEDICAL DECISION-MAKING; PROCESS CONTROL; REAL-TIME; WEANING FROM MECHANICAL VENTILATION;

D O I：

10.1007/BF01133619

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

The procedure for weaning a patient with respiratory insufficiency from mechanical ventilation may be complex and requires expertise obtained by long clinical practice. We designed a knowledge-based system for the management of patients receiving respiratory support and implemented a weaning procedure. The system is intended for patients whose spontaneous respiratory activity is assisted by a Hamilton Veolar ventilator delivering a positive pressure plateau during inspiration (Pressure Support Ventilation mode). Our closed-loop real-time system running on a Personal Computer continuously adapts the assistance provided by the ventilator to the patient's evolution, and indicates when the patient can be withdrawn from the ventilator. Three parameters are used to appreciate the 'respiratory comfort' of the patient: breathing frequency, which we consider the most informative index, tidal volume and end-tidal CO2 pressure. A preliminary study of 19 patients was performed to evaluate the ability of our system to adapt the assistance to the patient's needs, with the main objective of facilitating weaning by gradually lowering the level of assistance. In 10 of these patients, considered as good candidates for weaning on the strength of objective criteria, the system maintained the breathing pattern in a zone of comfort for 95% of the period of assisted ventilation and stated that they were 'weanable'. This was consistent with the clinical evolution of all 10 patients. These results show that such a system can provide effective management for mechanically ventilated patients.

引用

页码：239 / 250

页数：12

共 16 条

[1]

Brochard L., Pluskwa F., Lemaire F., Improved efficacy of spontaneous breathing with inspiratory pressure support, Am Rev Respir Dis, 32, pp. 1110-16, (1987)

[2]

Brochard L., Harf A., Lorino H., Lemaire F., Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation, Am Rev Respir Dis, 139, pp. 513-21, (1989)

[3]

MacIntyre N.R., Respiratory function during pressure support ventilation, Chest, 89, pp. 677-83, (1986)

[4]

Fagan L.M., Representing time dependant relations in a medical setting, (1980)

[5]

Miller P.L., Goal directed critiquing by computer: ventilator management, Comput Biomed Res, 18, pp. 422-38, (1985)

[6]

Hernandez-Sande C., Moret-Bonillo V., Alonso-Betanzos A., ESTER — an expert system for management of respiratory weaning therapy, IEEE Trans Biom Eng, 36, pp. 551-64, (1989)

[7]

Rudowski R., Frostell C., Gill H., A knowledge-based support system for mechanical ventilation of the lungs. The KUSIVAR concept and prototype, Comput Biomed Res, 30, pp. 59-70, (1989)

[8]

Sittig D.F., A computerized patient advice system to direct ventilatory care, (1986)

[9]

Brochard L., Rua F., Lorino H., Lemaire F., Harf A., Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube, Anesthesiology, 75, pp. 739-45, (1991)

[10]

Zimolong B., Shimon Y.N., Ray E.E., Salvendy G., On the limits of expert systems and engineering models in process control, Behavior and Information Technology, 6, pp. 5-36, (1986)

← 1 2 →