Mechanical ventilation is one of the most common life-supporting interventions used in critically ill patients in the Intensive Care Unit (ICU). Ventilatory support is a life-saving intervention, however, it can also be harmful to the patient, hence, optimising ventilator support is a challenging task for physicians. A commonly encountered problem in critically ill, mechanically ventilated patients is the presence of ineffective efforts, that is a failure of the ventilator to be triggered and support patient’s breath. Partners of the AEGLE project have shown that patients having clusters of ineffective efforts, defined as ‘Events’ (IEEVs), are more likely to stay longer in the ICU, and have higher mortality. Preventing or minimising the duration of IEEVs could potentially influence short- and long-term patient outcomes.
Ideally, a smart alarm can identify the presence of IEEVs in real-time and early on, facilitating better management of IEEVs. While smart alarms based on advanced analytics could identify IEEVs, it is important to estimate their potential before investing valuable time and money in their development.
We estimated the potential health and economic benefits of these smart alarms for improved management of IEEVs. We graphically depicted the factors which increase or decrease costs and health benefits after implementing a smart alarm for better management of IEEVs in the figure below.
Our analysis suggests that it is worthwhile to develop smart alarms adopting advanced analytics that identify IEEVs. Improved management of IEEVs could result in more health benefits (0.26 quality-adjusted life years) and lower costs (-€314), on average per patient, compared to current care. Scenario analyses revealed that even if the analytics were to improve outcomes for a fraction of patients (>5%), introducing the alarm would still be preferred to current care.
Katerina Vaporidi (PAGNI – University Hospital of Heraklion)
Lytske Bakker (Erasmus Universiteit Rotterdam)