Extubation Advisor combines a respiratory rate variability-derived predictive model of the risk of extubation failure called the WAVE score, the rapid shallow breathing index (RSBI), Respiratory Therapist clinical impression of extubation failure risk, and a standardized extubation readiness checklist during a spontaneous breathing trial (SBT) to generate an extubation report summary for clinical decision-making.
Extubation Advisor provides a standardized snapshot of patient performance during a SBT and is intended to aid in the clinical assessment of extubation readiness of ventilated patients. Recognizing that extubation decision making is complex and should incorporate all relevant information (including but not limited to patient history, illness, function and values - some of which may not be included with this tool), EA™ is meant to supplement other contributing decision-making factors in order to minimize extubation failure and enhance patient care.
Extubation Advisor analyzes capnography waveforms during a SBT to provide a Weaning And Variability Evaluation (WAVE) score. The WAVE score evaluates respiratory rate variability, an indicator of pulmonary function, when a patient is subject to an increased respiratory workload during a SBT to provide a probabilistic estimate of the risk of extubation failure. The WAVE score and associated predictive model was derived from a large multicenter international study of 800 patients. (DOI: 10.1186/cc13822)
Extubation Advisor is intended for adult patients (18 years of age) with or without COVID-19 in the Intensive Care Unit who have been on invasive mechanical ventilation for > 48hrs by endotracheal tube and are deemed clinically ready for a spontaneous breathing trial for extubation assessment purposes.
While it does not matter what mode of ventilation the patient is on prior to the SBT, Extubation advisor utilizes pressure-support ventilation during the SBT to assess extubation readiness. Specific weaning criteria for PS, PEEP and FiO2 are institution-dependent and are not mandated by EATM.
15 minutes of uninterrupted recording during a SBT is required (at minimum) to generate a report. There is no maximum SBT time.
The EA™ application collects and stores each SBT report on a local or centralized hospital database for easy retrieval. Recorded waveforms can also be kept for future analysis.
The EA™ application can optionally send the generated reports via email to a primary care provider, or they can be printed to a networked or locally attached printer, if available. Both these options are configured in the EA™ application.
The generated reports can optionally be sent to an electronic medical record (EMR) system (site-dependent).
Multiple SBTs can be recorded for a single patient and reports visible within the EA™ interface for that patient. All generated reports can be found under the SBT Snapshot dashboard on the application for quick retrieval and evaluation.
The WAVE score utilizes the breath-by-breath time intervals extrapolated from the capnography waveforms in order to generate an extubation risk score. EA™ does not require a specific capnography monitor providing the device fits in-line with the ventilator circuit and can connect to a supported patient monitor.
EA™ has been validated for use on two major families of patient monitors – Philips IntelliVue Series and GE Datex and Carescape monitors. Some monitors may require specific vendor add-on cards to be compatible with EATM.
EA™ is approved for clinical use by Health Canada (Licence 110048) and the EU (CЄ)
