human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A 2-h T-tube trial of spontaneous breathing was used in selecting patients ready for extubation and discontinuation of mechanical ventilation . However , some doubt remains as to whether it is the most appropriate method of performing a spontaneous breathing trial . We carried out a prospect i ve , r and omized , multicenter study involving patients who had received mechanical ventilation for more than 48 h and who were considered by their physicians to be ready for weaning according to clinical criteria and st and ard weaning parameters . Patients were r and omly assigned to undergo a 2-h trial of spontaneous breathing in one of two ways : with a T-tube system or with pressure support ventilation of 7 cm H2O . If a patient had signs of poor tolerance at any time during the trial , mechanical ventilation was reinstituted . Patients without these features at the end of the trial were extubated . Of the 246 patients assigned to the T-tube group , 192 successfully completed the trial and were extubated ; 36 of them required reintubation . Of the 238 patients in the group receiving pressure support ventilation  , 205 were extubated and 38 of them required reintubation . The percentage of patients who remained extubated after 48 h was not different between the two groups ( 63 % T-tube , 70 % pressure support ventilation , p = 0.14 ) . The percentage of patients falling the trial was significantly higher when the T-tube was used ( 22 versus 14 % , p = 0.03 ) . Clinical evolution during the trial was not different in patients reintubated and successfully extubated . ICU mortality among reintubated patients was significantly higher than in successfully extubated patients ( 27 versus 2.6 % , p < 0.001 ) . Spontaneous breathing trials with pressure support or T-tube are suitable methods for successful discontinuation of ventilator support in patients without problems to resume spontaneous breathing Introduction Reduction of automatic pressure support based on a target respiratory frequency or m and atory rate ventilation ( MRV ) is available in the Taema-Horus ventilator for the weaning process in the intensive care unit ( ICU ) setting . We hypothesised that MRV is as effective as manual weaning in post-operative ICU patients . Methods There were 106 patients selected in the post-operative period in a prospect i ve , r and omised , controlled protocol . When the patients arrived at the ICU after surgery , they were r and omly assigned to either : traditional weaning , consisting of the manual reduction of pressure support every 30 minutes , keeping the respiratory rate/tidal volume ( RR/TV ) below 80 L until 5 to 7 cmH2O of pressure support ventilation ( PSV ) ; or automatic weaning , referring to MRV set with a respiratory frequency target of 15 breaths per minute ( the ventilator automatically decreased the PSV level by 1 cmH2O every four respiratory cycles , if the patient 's RR was less than 15 per minute ) . The primary endpoint of the study was the duration of the weaning process . Secondary endpoints were levels of pressure support , RR , TV ( mL ) , RR/TV , positive end expiratory pressure levels , FiO2 and SpO2 required during the weaning process , the need for reintubation and the need for non-invasive ventilation in the 48 hours after extubation . Results In the intention to treat analysis there were no statistically significant differences between the 53 patients selected for each group regarding gender ( p = 0.541 ) , age ( p = 0.585 ) and type of surgery ( p = 0.172 ) . Nineteen patients presented complications during the trial ( 4 in the PSV manual group and 15 in the MRV automatic group , p < 0.05 ) . Nine patients in the automatic group did not adapt to the MRV mode . The mean ± sd ( st and ard deviation ) duration of the weaning process was 221 ± 192 for the manual group , and 271 ± 369 minutes for the automatic group ( p = 0.375 ) . PSV levels were significantly higher in MRV compared with that of the PSV manual reduction ( p < 0.05 ) . Reintubation was not required in either group . Non-invasive ventilation was necessary for two patients , in the manual group after cardiac surgery ( p = 0.51 ) . Conclusions The duration of the automatic reduction of pressure support was similar to the manual one in the post-operative period in the ICU , but presented more complications , especially no adaptation to the MRV algorithm . Trial Registration Trial registration number : IS RCT OBJECTIVE To compare a practice of protocol -directed sedation during mechanical ventilation implemented by nurses with traditional non- protocol -directed sedation administration . DESIGN R and omized , controlled clinical trial . SETTING Medical intensive care unit ( 19 beds ) in an urban teaching hospital . PATIENTS Patients requiring mechanical ventilation ( n = 321 ) . INTERVENTIONS Patients were r and omly assigned to receive either protocol -directed sedation ( n = 162 ) or non- protocol -directed sedation ( n = 159 ) . MEASUREMENTS AND MAIN RESULTS The median duration of mechanical ventilation was 55.9 hrs ( 95 % confidence interval , 41.0 - 90.0 hrs ) for patients managed with protocol -directed sedation and 117.0 hrs ( 95 % confidence interval , 96.0 - 155.6 hrs ) for patients receiving non- protocol -directed sedation . Kaplan-Meier analysis demonstrated that patients in the protocol -directed sedation group had statistically shorter duration s of mechanical ventilation than patients in the non- protocol -directed sedation group ( chi-square = 7.00 , p = .008 , log rank test ; chi-square = 8.54 , p = .004 , Wilcoxon 's test ; chi-square = 9.18 , p = .003 , -2 log test ) . Lengths of stay in the intensive care unit ( 5.7+/-5.9 days vs. 7.5+/-6.5 days ; p = .013 ) and hospital ( 14.0+/-17.3 days vs. 19.9+/-24.2 days ; p < .001 ) were also significantly shorter among patients in the protocol -directed sedation group . Among the 132 patients ( 41.1 % ) receiving continuous intravenous sedation , those in the protocol -directed sedation group ( n = 66 ) had a significantly shorter duration of continuous intravenous sedation than those in the non- protocol -directed sedation group ( n = 66 ) ( 3.5+/-4.0 days vs. 5.6+/-6.4 days ; p = .003 ) . Patients in the protocol -directed sedation group also had a significantly lower tracheostomy rate compared with patients in the non- protocol -directed sedation group ( 10 of 162 patients [ 6.2 % ] vs. 21 of 159 patients [ 13.2 % ] , p = .038 ) . CONCLUSIONS The use of protocol -directed sedation can reduce the duration of mechanical ventilation , the intensive care unit and hospital lengths of stay , and the need for tracheostomy among critically ill patients with acute respiratory failure This prospect i ve study compared two weaning modalities in COPD patients requiring mechanical ventilation ( MV ) for acute respiratory failure . Nineteen patients with COPD were studied when their precipitating illness was controlled . Although they satisfied the conventional bedside weaning criteria , they could not tolerate any reduction in the respirator rate below 10 cycles/min . At this time , patients were r and omized into two groups receiving either synchronized intermittent m and atory ventilation ( SIMV ) with pressure support ventilation ( PSV ) ( group 1 ) or SIMV alone ( group 2 ) . The volumetric support of ventilation  ( SIMV rate ) was progressively decreased in both groups according to the patient 's tolerance with a concurrent decrease in the barometric support of ventilation ( PSV levels from 15 cm H2O to 6 cm H2O ) . At each step of SIMV rate , we found no difference between group 1 and group 2 in arterial blood gases , blood pressure , heart rate , airway occlusion pressure , maximal inspiratory pressure , and oxygen cost of breathing ( OCB ) . At each step , however , group 1 patients showed significantly higher spontaneous tidal volume and lower spontaneous breathing frequency than did group 2 patients . We found a slight but not significant tendency to a shorter weaning period with than without PSV , but no difference in the weaning success . We concluded that ( 1 ) conventional weaning criteria might be inaccurate in COPD patients , ( 2 ) SIMV appeared very useful in weaning COPD patients from MV , ( 3 ) PSV marginally reduced the weaning period when added to SIMV , and ( 4 ) the OCB was not significantly improved with PSV We prospect ively investigated the large-scale implementation of a respiratory-therapist-driven protocol ( TDP ) that included 117 respiratory care practitioners ( RCPs ) managing 1,067 patients with respiratory failure over 9,048 patient days of mechanical ventilation . During a 12-mo period , we reintroduced a previously vali date d protocol that included a daily screen ( DS ) coupled with spontaneous breathing trials ( SBTs ) and physician prompt , as a TDP without daily input from a physician or " weaning team . " With grade d , staged educational interventions at 2-mo intervals , RCPs had a 97 % completion rate and a 95 % correct interpretation rate for the DS . The frequency with which patients who passed the DS underwent SBTs increased throughout the implementation process ( p < 0.001 ) . As the year progressed , RCPs more often considered SBTs once patients had passed a DS ( p < 0.001 ) , and physicians ordered more SBTs ( 46 versus 65 % , p = 0.004 ) . Overall , SBTs were ordered more often on the medicine than on the surgical services ( 81 versus 63 % , p = 0.001 ) , likely reflecting medical intensivists ' prior use of this protocol . Important barriers to protocol compliance were identified through a question naire ( 89 respondents , 76 % ) , and included : Physician unfamiliarity with the protocol , RCP inconsistency in seeking an order for an SBT from the physician , specific reasons cited by the physician for not advancing the patient to a SBT , and lack of stationary unit assignments by RCPs performing the protocol . We conclude that implementation of a vali date d weaning strategy is feasible as a TDP without daily supervision from a weaning physician or team . RCPs can appropriately perform and interpret DS data more than 95 % of the time , but significant barriers to SBTs exist . Through a staged implementation process , using periodic reinforcement of all participants in ventilator management , improved compliance with this large-scale weaning protocol can be achieved RATIONALE AND OBJECTIVES Duration of weaning from mechanical ventilation  may be reduced by the use of a systematic approach . We assessed whether a closed-loop knowledge-based algorithm introduced in a ventilator to act as a computer-driven weaning protocol can improve patient outcomes as compared with usual care . METHODS AND MEASUREMENTS We conducted a multicenter r and omized controlled study with concealed allocation to compare usual care for weaning with computer-driven weaning . The computerized protocol included an automatic gradual reduction in pressure support , automatic performance of spontaneous breathing trials ( SBT ) , and generation of an incentive message when an SBT was successfully passed . One hundred forty-four patients were enrolled before weaning initiation . They were r and omly allocated to computer-driven weaning or to physician-controlled weaning according to local guidelines . Weaning duration until successful extubation and total duration of ventilation were the primary endpoints . MAIN RESULTS Weaning duration was reduced in the computer-driven group from a median of 5 to 3 d ( p=0.01 ) and total duration of mechanical ventilation from 12 to 7.5 d ( p=0.003 ) . Reintubation rate did not differ ( 23 vs. 16 % , p=0.40 ) . Computer-driven weaning also decreased median intensive care unit ( ICU ) stay duration from 15.5 to 12 d ( p=0.02 ) and caused no adverse events . The amount of sedation did not differ between groups . In the usual care group , compliance to recommended modes and to SBT was estimated , respectively , at 96 and 51 % . CONCLUSIONS The specific computer-driven system used in this study can reduce mechanical ventilation duration and ICU length of stay , as compared with a physician-controlled weaning process Objective To evaluate the ability of a computer-driven system ( CDS ) to manage pressure-support ventilation over prolonged periods and to predict weaning readiness compared to intensivists . The system continuously adapts pressure support , gradually decreases ventilatory assistance when possible , and indicates weaning readiness . Design and setting A two-center , prospect i ve , open , clinical , pilot study in medical ICUs of two university hospitals . Patients and participants 42 consecutive mechanically ventilated patients ( 60±14 years , SAPS II 39±15 ) , 9 of whom were excluded . Interventions As soon as patients could tolerate pressure support , they were ventilated with the CDS . The times of weaning readiness determined by the intensivists and CDS were compared . Measurements and results Weaning was successful in 25 patients and failed in 7 ; unplanned extubation occurred in 1 patient . Time on CDS ventilation was 3±3 days ( maximum , 12 days ) . The CDS  detected weaning readiness earlier than the intensivists in 17 patients , and intensivists 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A 2-h T-tube trial of spontaneous breathing was used in selecting patients ready for extubation and discontinuation of mechanical ventilation . However , some doubt remains as to whether it is the most appropriate method of performing a spontaneous breathing trial . We carried out a prospect i ve , r and omized , multicenter study involving patients who had received mechanical ventilation for more than 48 h and who were considered by their physicians to be ready for weaning according to clinical criteria and st and ard weaning parameters . Patients were r and omly assigned to undergo a 2-h trial of spontaneous breathing in one of two ways : with a T-tube system or with pressure support ventilation of 7 cm H2O . If a patient had signs of poor tolerance at any time during the trial , mechanical ventilation was reinstituted . Patients without these features at the end of the trial were extubated . Of the 246 patients assigned to the T-tube group , 192 successfully completed the trial and were extubated ; 36 of them required reintubation . Of the 238 patients in the group receiving pressure support ventilation  , 205 were extubated and 38 of them required reintubation . The percentage of patients who remained extubated after 48 h was not different between the two groups ( 63 % T-tube , 70 % pressure support ventilation , p = 0.14 ) . The percentage of patients falling the trial was significantly higher when the T-tube was used ( 22 versus 14 % , p = 0.03 ) . Clinical evolution during the trial was not different in patients reintubated and successfully extubated . ICU mortality among reintubated patients was significantly higher than in successfully extubated patients ( 27 versus 2.6 % , p < 0.001 ) . Spontaneous breathing trials with pressure support or T-tube are suitable methods for successful discontinuation of ventilator support in patients without problems to resume spontaneous breathing Introduction Reduction of automatic pressure support based on a target respiratory frequency or m and atory rate ventilation ( MRV ) is available in the Taema-Horus ventilator for the weaning process in the intensive care unit ( ICU ) setting . We hypothesised that MRV is as effective as manual weaning in post-operative ICU patients . Methods There were 106 patients selected in the post-operative period in a prospect i ve , r and omised , controlled protocol . When the patients arrived at the ICU after surgery , they were r and omly assigned to either : traditional weaning , consisting of the manual reduction of pressure support every 30 minutes , keeping the respiratory rate/tidal volume ( RR/TV ) below 80 L until 5 to 7 cmH2O of pressure support ventilation ( PSV ) ; or automatic weaning , referring to MRV set with a respiratory frequency target of 15 breaths per minute ( the ventilator automatically decreased the PSV level by 1 cmH2O every four respiratory cycles , if the patient 's RR was less than 15 per minute ) . The primary endpoint of the study was the duration of the weaning process . Secondary endpoints were levels of pressure support , RR , TV ( mL ) , RR/TV , positive end expiratory pressure levels , FiO2 and SpO2 required during the weaning process , the need for reintubation and the need for non-invasive ventilation in the 48 hours after extubation . Results In the intention to treat analysis there were no statistically significant differences between the 53 patients selected for each group regarding gender ( p = 0.541 ) , age ( p = 0.585 ) and type of surgery ( p = 0.172 ) . Nineteen patients presented complications during the trial ( 4 in the PSV manual group and 15 in the MRV automatic group , p < 0.05 ) . Nine patients in the automatic group did not adapt to the MRV mode . The mean ± sd ( st and ard deviation ) duration of the weaning process was 221 ± 192 for the manual group , and 271 ± 369 minutes for the automatic group ( p = 0.375 ) . PSV levels were significantly higher in MRV compared with that of the PSV manual reduction ( p < 0.05 ) . Reintubation was not required in either group . Non-invasive ventilation was necessary for two patients , in the manual group after cardiac surgery ( p = 0.51 ) . Conclusions The duration of the automatic reduction of pressure support was similar to the manual one in the post-operative period in the ICU , but presented more complications , especially no adaptation to the MRV algorithm . Trial Registration Trial registration number : IS RCT OBJECTIVE To compare a practice of protocol -directed sedation during mechanical ventilation implemented by nurses with traditional non- protocol -directed sedation administration . DESIGN R and omized , controlled clinical trial . SETTING Medical intensive care unit ( 19 beds ) in an urban teaching hospital . PATIENTS Patients requiring mechanical ventilation ( n = 321 ) . INTERVENTIONS Patients were r and omly assigned to receive either protocol -directed sedation ( n = 162 ) or non- protocol -directed sedation ( n = 159 ) . MEASUREMENTS AND MAIN RESULTS The median duration of mechanical ventilation was 55.9 hrs ( 95 % confidence interval , 41.0 - 90.0 hrs ) for patients managed with protocol -directed sedation and 117.0 hrs ( 95 % confidence interval , 96.0 - 155.6 hrs ) for patients receiving non- protocol -directed sedation . Kaplan-Meier analysis demonstrated that patients in the protocol -directed sedation group had statistically shorter duration s of mechanical ventilation than patients in the non- protocol -directed sedation group ( chi-square = 7.00 , p = .008 , log rank test ; chi-square = 8.54 , p = .004 , Wilcoxon 's test ; chi-square = 9.18 , p = .003 , -2 log test ) . Lengths of stay in the intensive care unit ( 5.7+/-5.9 days vs. 7.5+/-6.5 days ; p = .013 ) and hospital ( 14.0+/-17.3 days vs. 19.9+/-24.2 days ; p < .001 ) were also significantly shorter among patients in the protocol -directed sedation group . Among the 132 patients ( 41.1 % ) receiving continuous intravenous sedation , those in the protocol -directed sedation group ( n = 66 ) had a significantly shorter duration of continuous intravenous sedation than those in the non- protocol -directed sedation group ( n = 66 ) ( 3.5+/-4.0 days vs. 5.6+/-6.4 days ; p = .003 ) . Patients in the protocol -directed sedation group also had a significantly lower tracheostomy rate compared with patients in the non- protocol -directed sedation group ( 10 of 162 patients [ 6.2 % ] vs. 21 of 159 patients [ 13.2 % ] , p = .038 ) . CONCLUSIONS The use of protocol -directed sedation can reduce the duration of mechanical ventilation , the intensive care unit and hospital lengths of stay , and the need for tracheostomy among critically ill patients with acute respiratory failure This prospect i ve study compared two weaning modalities in COPD patients requiring mechanical ventilation ( MV ) for acute respiratory failure . Nineteen patients with COPD were studied when their precipitating illness was controlled . Although they satisfied the conventional bedside weaning criteria , they could not tolerate any reduction in the respirator rate below 10 cycles/min . At this time , patients were r and omized into two groups receiving either synchronized intermittent m and atory ventilation ( SIMV ) with pressure support ventilation ( PSV ) ( group 1 ) or SIMV alone ( group 2 ) . The volumetric support of ventilation  ( SIMV rate ) was progressively decreased in both groups according to the patient 's tolerance with a concurrent decrease in the barometric support of ventilation ( PSV levels from 15 cm H2O to 6 cm H2O ) . At each step of SIMV rate , we found no difference between group 1 and group 2 in arterial blood gases , blood pressure , heart rate , airway occlusion pressure , maximal inspiratory pressure , and oxygen cost of breathing ( OCB ) . At each step , however , group 1 patients showed significantly higher spontaneous tidal volume and lower spontaneous breathing frequency than did group 2 patients . We found a slight but not significant tendency to a shorter weaning period with than without PSV , but no difference in the weaning success . We concluded that ( 1 ) conventional weaning criteria might be inaccurate in COPD patients , ( 2 ) SIMV appeared very useful in weaning COPD patients from MV , ( 3 ) PSV marginally reduced the weaning period when added to SIMV , and ( 4 ) the OCB was not significantly improved with PSV We prospect ively investigated the large-scale implementation of a respiratory-therapist-driven protocol ( TDP ) that included 117 respiratory care practitioners ( RCPs ) managing 1,067 patients with respiratory failure over 9,048 patient days of mechanical ventilation . During a 12-mo period , we reintroduced a previously vali date d protocol that included a daily screen ( DS ) coupled with spontaneous breathing trials ( SBTs ) and physician prompt , as a TDP without daily input from a physician or " weaning team . " With grade d , staged educational interventions at 2-mo intervals , RCPs had a 97 % completion rate and a 95 % correct interpretation rate for the DS . The frequency with which patients who passed the DS underwent SBTs increased throughout the implementation process ( p < 0.001 ) . As the year progressed , RCPs more often considered SBTs once patients had passed a DS ( p < 0.001 ) , and physicians ordered more SBTs ( 46 versus 65 % , p = 0.004 ) . Overall , SBTs were ordered more often on the medicine than on the surgical services ( 81 versus 63 % , p = 0.001 ) , likely reflecting medical intensivists ' prior use of this protocol . Important barriers to protocol compliance were identified through a question naire ( 89 respondents , 76 % ) , and included : Physician unfamiliarity with the protocol , RCP inconsistency in seeking an order for an SBT from the physician , specific reasons cited by the physician for not advancing the patient to a SBT , and lack of stationary unit assignments by RCPs performing the protocol . We conclude that implementation of a vali date d weaning strategy is feasible as a TDP without daily supervision from a weaning physician or team . RCPs can appropriately perform and interpret DS data more than 95 % of the time , but significant barriers to SBTs exist . Through a staged implementation process , using periodic reinforcement of all participants in ventilator management , improved compliance with this large-scale weaning protocol can be achieved RATIONALE AND OBJECTIVES Duration of weaning from mechanical ventilation  may be reduced by the use of a systematic approach . We assessed whether a closed-loop knowledge-based algorithm introduced in a ventilator to act as a computer-driven weaning protocol can improve patient outcomes as compared with usual care . METHODS AND MEASUREMENTS We conducted a multicenter r and omized controlled study with concealed allocation to compare usual care for weaning with computer-driven weaning . The computerized protocol included an automatic gradual reduction in pressure support , automatic performance of spontaneous breathing trials ( SBT ) , and generation of an incentive message when an SBT was successfully passed . One hundred forty-four patients were enrolled before weaning initiation . They were r and omly allocated to computer-driven weaning or to physician-controlled weaning according to local guidelines . Weaning duration until successful extubation and total duration of ventilation were the primary endpoints . MAIN RESULTS Weaning duration was reduced in the computer-driven group from a median of 5 to 3 d ( p=0.01 ) and total duration of mechanical ventilation from 12 to 7.5 d ( p=0.003 ) . Reintubation rate did not differ ( 23 vs. 16 % , p=0.40 ) . Computer-driven weaning also decreased median intensive care unit ( ICU ) stay duration from 15.5 to 12 d ( p=0.02 ) and caused no adverse events . The amount of sedation did not differ between groups . In the usual care group , compliance to recommended modes and to SBT was estimated , respectively , at 96 and 51 % . CONCLUSIONS The specific computer-driven system used in this study can reduce mechanical ventilation duration and ICU length of stay , as compared with a physician-controlled weaning process Objective To evaluate the ability of a computer-driven system ( CDS ) to manage pressure-support ventilation over prolonged periods and to predict weaning readiness compared to intensivists . The system continuously adapts pressure support , gradually decreases ventilatory assistance when possible , and indicates weaning readiness . Design and setting A two-center , prospect i ve , open , clinical , pilot study in medical ICUs of two university hospitals . Patients and participants 42 consecutive mechanically ventilated patients ( 60±14 years , SAPS II 39±15 ) , 9 of whom were excluded . Interventions As soon as patients could tolerate pressure support , they were ventilated with the CDS . The times of weaning readiness determined by the intensivists and CDS were compared . Measurements and results Weaning was successful in 25 patients and failed in 7 ; unplanned extubation occurred in 1 patient . Time on CDS ventilation was 3±3 days ( maximum , 12 days ) . The CDS  detected weaning readiness earlier than the intensivists in 17 patients , and intensivists 
    Output:
    