Automation of Weaning in Children

This chapter describes the basics and the clinical experience with two explicit computerised protocols (ECP) implemented in commercialised ventilators: Smartcare/PS® by Draeger Medical (Germany) and IntelliVent® by Hamilton Medical (Switzerland). These two ECPs manage ventilation, without the need of caregivers’ intervention but under their supervision. SmartCare/PS® is an autopiloting, knowledge-based software application that provides an ECP for the automated control of pressure support ventilation. IntelliVent® is an explicit computerised protocol for the automated control of minute volume, PEEP and FiO2 in adaptive support ventilation (ASV). The main innovation of the two ECPs is the use of \( {ET}_{PCO_2} \) as a surrogate for blood gas PCO2, to decrease or increase ventilatory support. IntelliVent® also uses SpO2 to decrease or increase PEEP and FiO2. The two ECPs were studied in children during the weaning phase and the first clinical studies are promising. However, further clinical trials are needed to better assess the efficacy and tolerance of these two ECPs in children and to develop ECP that are dedicated to all ages including neonates.