Most of the literature points to a SBT as the best approach. Reading previous discussions on this topic most of the members tend to agree. Prelim reports on the Drager smartcare approach show some pretty impressive results.......up to 30% reduction in ventilator days according to the European studies. Is the smartcare not looking at an automatic gradual weaning of support over a longer period? If so seems to go against the theory of rest then wean.

For those needing a little more background on Smart Care:Smart Care info more info check page 16 and 17 I haven't worked with Smart Care. I've seen the demo, but can't speak from first hand. It looks like a SBT in CPAP/PSV with a decrease/increase of PSV based on the patient's physiological feedback. It appears to decrease as rapidly as possible within its programmed settings. By applying this approach consistently, it is reported to produce positive results. The weaning approach we use at the LTACH where I now work (until Wednesday, moving on after 10 yrs) has used much less sophisticated equipment (PB 760), but a similar approach, manually applied. When ready for weaning, we obtain parameters. If RSBI < 120 we allow them a SBT on T-piece or T-collar. If > 120 they go to CPAP with PSV adjusted to keep their RR < 36 as long as adequate VE is maintained. Weans are ended either way when predetermined physiological parameters are reached. Synchrony is also assessed in CPAP and severe disynchrony can also end a wean in CPAP. Once they have reached the weaning end point, we return them to rest and resume the next day. We are looking for the therapist in the CPAP weans to adjust support up or down as dictated by the patient's needs on an ongoing basis. I don't see this approach as much different, only more labor intensive, yet very successful. As you say the Smart Care doesn't seem to address the return to rest we have to use for our long slow weans, but I suppose the patient can be switched back to full support if that is the program. We do not wean in CPAP through the night. If they are not strong enough to start the day on T-piece then they get rested at night. We just about dial them out with set VE during rest. Their multi-center trials were most likely acute cares. Is this set it and forget it? How much clinician input in the process and support level once initiated? I know there must be some Drager users that have some first hand experience with this intriguing and relatively new tool. Reps are OK here too, if not too gushy Any links to the specific articles cited in my linked docs from Drager would be appreciated. What're your thoughts?

I applaud any ventilator company that offers closed-loop control. If you are interested in looking at automated weaning I would suggest that you also investigate Intelligent Ventilation from Hamilton Medical. I will not use this forum as a sales pitch. Closed-loop control however, is the new paradigm in health care. Commercial aviation learned long ago that automation (used correctly) provides a higher level of safety and effectiveness. True closed-loop control however, should address both the actively breathing patient and the sedated or non-actively breathing patient equally well. This will allow weaning to occur automatically as soon as the patient is ready.

Sounds like Inacurate(partly EtCo2 based) lazy way of weaning. ATC on at 100% with PEEP +5 has worked great for me. When a patient is ready to wean they will.

GJ,RRT,
I am sure your method works well for many, and perhaps Smart Care is a lazy or even non-labor intensive way to wean. I think it may be the lazy that are giving this product more of a potential market. That protocols work is well documented as long as they are adhered to consistently. One protocol may work better than another, but for the most part if they are well constructed they will all get the patient to the desired end point if it is possible, with perhaps a few hours or days one way or another. It is also a fact that in many cases the protocols that are in place are not ahdered to all that routinely. Perhaps by the lazy or the labor intense, but I wonder if we were all on the ball and worked the protocols we have or at least utilize the technology we have to it's fullest advantage would those selling Smart Care strike such a cord as they seem to have with some. Here is a piece from Focus's summer issue that seems to do a good job describing how Smart Care works http://www.foocus.com/pdfs/Articles/JulAug06/Mathews.pdf Thanks again for your insights.