2009 Volume 17 Issue 1 Pages 11-13
Smart Care ® (SC) is an automated weaning system which has been newly installed in the Evita XL Ventilator made by Dräger Medical (Lubeck, Germany). This study was performed to investigate the application of SC to postoperative respiratory management in patients with esophageal cancer, for the purpose of more objectively assessing postoperative weaning from the ventilator, which has largely been performed based on the individual physician's experience. This study included 8 patients with cancer of the thoracic esophagus who were weaned postoperatively from the ventilator using SC. The weaning was performed by adjusting the ventilator automatically using SC to decrease the preset pressure support (PS) level to 7 cmH2O, using spontaneous respiratory rate (F spont), expiratory tidal volume (Vte) and end-tidal carbon dioxide pressure (etCO2) as the assessment factors under the conditions of continuous positive airway pressure (CPAP) mode and a positive end expiratory pressure (PEEP) of 5 cm or less. In all 8 patients, weaning was accomplished with the display of the message "Consider Separation", in accordance with which the endotracheal tube was removed. The mean duration of intubation was 32 ± 4.0 hours, and that of SC use was 104.4 ± 42.8 minutes. SC proved remarkably useful in that all the patients had an uneventful course after the removal of the endotracheal tube and none required reintubation. It is expected in the future that the use of SC will enable the establishment of a uniform weaning protocol after esophageal cancer surgery, and this may contribute to the standardization and higher efficiency of postoperative respiratory management.
