Clinical decision support recommending ventilator settings during noninvasive ventilation

• Published in: Journal of clinical monitoring and computing 2020-10, Vol.34 (5), p.1043-1049
• Main Authors: Tams, Carl, Stephan, Paul, Euliano, Neil, Gabrielli, Andrea, Martin, A. Daniel, Efron, Philip, Patel, Rohit
• Format: Article
• Language: English
• Subjects: Advisors; Algorithms; Anesthesiology; Brief Communication; Critical Care Medicine; Health Sciences; Intensive; Medicine; Medicine & Public Health; Oxygen therapy; Oxygenation; Parameters; Statistics for Life Sciences; Therapists; Titration; Ventilation; Ventilators
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-019-00409-6

NIV therapy is used to provide positive pressure ventilation for patients. There are protocols describing what ventilator settings to use to initialize NIV; however, the guidelines for titrating ventilator settings are less specific. We developed an advisory system to recommend NIV ventilator setting titration and recorded respiratory therapist agreement rates at the bedside. We developed an algorithm (NIV advisor) to recommend when to change the non-invasive ventilator settings of IPAP, EPAP, and FiO 2 based on patient respiratory parameters. The algorithm utilized a multi-target approach; oxygenation, ventilation, and patient effort. The NIV advisor recommended ventilator settings to move the patient’s respiratory parameters in a preferred target range. We implemented a pilot study evaluating the usability of the NIV advisor on 10 patients receiving critical care with non-invasive ventilation (NIV). Respiratory therapists were asked their agreement on recommendations from the NIV advisor at the patient’s bedside. Bedside respiratory therapists agreed with 91% of the ventilator setting recommendations from the NIV advisor. The POB and VT values were the respiratory parameters that were most often out of the preferred target range. The IPAP ventilator setting was the setting most often considered in need of changing by the NIV advisor. The respiratory therapists agreed with the majority of the recommendations from the NIV advisor. We consider the IPAP recommendations informative in providing the respiratory therapist assistance in targeting preferred POB and Vt values, as these values were frequently out of the target ranges. This pilot implementation was unable to produce the results required to determine the value of the EPAP recommendations. The FiO 2 recommendations from the NIV advisor were treated as ancillary information behind the IPAP recommendations.