The Intensive Care Unit (ICU) is one of the most resource demanding, complex and expensive units in the hospital, consuming 20% (€70Bn in Europe) of all hospital costs. Approximately 40% of all ICU patients require support for breathing through mechanical ventilation, with 6-10% of these being very difficult to manage and return to normal breathing without mechanical support. This group of patients often have an extended Length of Stay (LOS) at the ICU, making their quality of care difficult and expensive, with the management of these patients consuming about 37% (€26Bn in Europe) of all ICU cost. The complex nature of these patients means that decision on improving mechanical ventilation are required throughout the day and night, with these decisions taken by clinicians expert in mechanical ventilation, i.e. ICU doctors or respiratory therapists (RT).
This need for 24-hour care from clinical experts, is not consistent with current practice. Typically, the ICU doctor/RT sees the patients during their rounds, which take place 2-3 times per day with approximately 5-10 minutes per patient, insufficient to provide the care necessary for the 6-10% most complex patients who incur 37% of all ICU cost. Previous studies have shown, that dramatic LOS reduction is possible if a team of RTs managing patients around the clock provides care. However, in practice this is not possible – as 1) the resources are not available and 2) allocation of such resource would mean a dramatic increase in the cost of mechanical ventilation
Tools to assist the respiratory therapist in optimizing the ventilatory management are therefore required, particularly as an Assist system, which can advise on how to optimize the patients’ ventilation management.
Current technologies for ICU ventilation management on the market today are rule or protocol-based closed- or open-loop systems controlling the ventilatory support to the patient, meaning that the level of support is adjusted based on fixed clinical rules and guidelines for patient groups.
The shortcomings are that the ventilatory support is fixed for individual patients within those groups and does not adjust to the patient condition or current state of physiology. Or in other words:
- The competing goals of ventilation may not be adequately balanced
- Changes in the patient’s physiological state may be misinterpreted
Therefore, these systems are appropriate for keeping a patient in a “zone of comfort” but not for understanding the underlying physiological state of each individual patient.
The inclusion of patient models of the ventilatory assist system, as in the BEACON Caresystem, can support clinicians in the selection of ventilator settings on an individual patient basis.
BEACON is implemented as an adjunct device on the side or on the top of a third party legally marketed ICU mechanical ventilator or mounted on a Trolley, which is placed near a third party legally marketed ICU mechanical ventilator.
BEACON has been designed to provide the clinician with recommendations for adjusting ventilator settings to manage the patient’s ventilation.
This is done by collating key inputs measured by BEACON; data inputs from the ventilator and manual data entry by the clinician into a computerprogramme that has been designed to assist clinical decisions for changes to the ventilator settings.
The recommendation is provided to the clinician in a clear and easy-to-use graphical format, the BEACON Advice screen: