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Knowledge-based system for the management of mechanical ventilation in Intensive Care Units (ICUs)
| developed by |
clinical domains |
keywords |
| Draeger Medical, Intensive Care, Hôpital Henri Mondor, Créteil, France and
the French National Institute for Health and Medical Research (INSERM). |
Management of mechanical ventilation in Intensive Care Units |
Knowledge-based system, clinical guidelines |
| location |
commissioned |
status |
| Hôpital Henri Mondor, Créteil, France;
Hospital Sant Pau, Barcelona, Spain;
University Hospital, Geneva, Switzerland;
Cliniques Universitaires St-Luc, Bruxelles, Belgique;
Università Cattolica, Rome, Italy;
AKH Wien, Wien, Austria;
University Hospital, Dresden, Germany;
University Hospital, Kiel, Germany;
Hôpital Bichat, Bichat, France;
Bristol Royal Infirmary, Bristol, UK. |
A version of Automedon has been in use at the Hôpital Henri Mondor, Créteil, France since 2001.
Automedon has been embedded in Dräger Medical's
EvitaXL ventilator system (commissioned mid-2003).
The embedded guideline engine is a Dräger Medical product
called SmartCare.
The PC implementation of Automedon is is fully
EU-approved but designed for research use
by Dräger customers (university hospitals etc). |
In clinical use |
| description |
|
Automedon is a knowledge based workbench and methodology for computerizing, automating and executing clinical
guidelines applied to
critical care ventilators.
Automedon is a successor to and enhancement of the NéoGanesh system,
and complies with industrial
requirements and regulatory quality standards such as ISO-EN 46001 and ISO 9000.
With Automedon, every clinical guideline that is appropriate for a given ventilator can be automated.
The core paradigm is that
if a medical device, i.e. ventilator allows for read access to its measurements, settings and contextual
information
(alarms, manoeuvres ...) as well as for write access to all its settings, then every clinical guideline
for that medical device is potentially applicable.
The underlying methodology comprises knowledge engineering techniques, e.g. for eliciting, modelling and
computerizing
clinical guidelines, expert system techniques e.g. rule based forward chaining with temporal reasoning and
software engineering
techniques, e.g. for automated source code generation and integration with the ventilator.
A clinical guideline for pressure support ventilation
has (January 2003)
been implemented with Automedon for Dräger’s
Evita 4 ventilator system.
This EU-approved system has
been successfully utilized in clinical practice in a study based in two separate centres.
Its clinical benefit is currently being evaluated by
a multi-centre european study involving six university hospitals.
Dräger is also marketing the PC implementation of Automedon.
The pressure support system was introduced in 2003, embedded to Draeger’s new EvitaXL ventilator.
Automedon has been superseded by SmartCare™ technology and
SmartCare™/PS (Pressure Support): a knowledge-based
system for the management of mechanical ventilation in
Intensive Care Units.
|
| references |
| Mersmann S, Dojat M. A Flexible System Architecture for Implementation of Protocol-Based Controllers in Mechanical Ventilation. Proceedings of Workshop on "Computers in Anaesthesia and Intensive Care: Knowledge-Based Information Management" July 1th, Cascais (PT), (2001)
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| Dojat M, Pachet F, Guessoum Z, Touchard D, Harf A, Brochard L, NéoGanesh: a Working System for the Automated Control of Assisted Ventilation in ICUs, Art Intell Med, 11,97-117, (1997)
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| Dojat M, Harf A, Touchard D, Lemaire F and Brochard L. Clinical Evaluation of a Computer-Controlled Pressure Support Mode, Am. J. Respir. Crit. Care Med. 2000;161:1161-66.
[PubMed]
[American Journal of Respiratory and Critical Care Medicine]
|
"
We have designed a computerized system providing closed-loop control of the level of pressure support ventilation (PSV). The system sets itself at the lowest level of PSV that maintains respiratory rate (RR), tidal volume (VT), and end-tidal CO(2) pressure (PET(CO(2))) within predetermined ranges defining acceptable ventilation (i.e., 12 < RR < 28 cycles/min, VT> 300 ml [> 250 if weight < 55 kg], and PET(CO(2)) < 55 mm Hg [< 65 mm Hg if chronic CO(2) retention]). Ten patients received computer-controlled (automatic) PSV and physician-controlled (standard) PSV, in random order, during 24 h for each mode. An estimation of occlusion pressure (P(0.1)) was recorded continuously. The average time spent with acceptable ventilation as previously defined was 66 +/- 24% of the total ventilation time with standard PSV versus 93 +/- 8% with automatic PSV (p < 0.05), whereas the level of PSV was similar during the two periods (17 +/- 4 cm H(2)O versus 19 +/- 6 cm H(2)O). The time spent with an estimated P(0.1) above 4 cm H(2)O was 34 +/- 35% of the standard PSV time versus only 11 +/- 17% of the automatic PSV time (p < 0.01). Automatic PSV increased the time spent within desired ventilation parameter ranges and apparently reduced periods of excessive workload.
" |
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Bouadma L, Lellouche F, Cabello B, Porta V, Deye N, Levy S, Mancebo J, Brochard L, Use of an Automated Control System to adapt the level of Pressure Support and manage Weaning, Proceedings of European Society of Intensive Care Medicine, Barcelona (ES), (2001)
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| contact |
links |
|
E: Michel Dojat (INSERM)
Michel.Dojat ujf-grenoble.fr
E: Stefan Mersmann (Dräger Medical)
Stefan.Mersmann draeger.com
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|
| acknowledgements |
| Michel DOJAT (INSERM);
Stefan Mersmann (Dräger Medical).
|
Entry on archive: March 20 2003
Last main update: March 25 2003; amendments July 18 2003
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Automedon: further information