NIHR SRMRC researchers design interactive approach to help critically ill patients off ventilators

03 October 2018

Researchers at the NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC) are using interactive technology to create a new patient-friendly way of weaning people off ventilator support after an extended period of chronic critical illness. Researchers based in Queen Elizabeth Hospital Birmingham are working with technology and product design firm Cambridge Design Partnership (CDP) on a ‘digital liberation from ventilation’ (DELVE) system.

The system gives patients easy-to-understand information on a screen about their breathing performance – both real time and historical – to engage them in the weaning process.

The dashboard will also enable clinicians to see at a glance a patient’s breathing performance and improve their understanding of an individual’s progress – mechanical ventilator devices currently provide no easy way of viewing historical patient data, so doctors usually piece together data from multiple sources such as vital signs monitors and clinician notes.

Many patients experience significant and persistent physical, psychological or social problems after discharge from intensive care units (ICUs). A key contributor to these issues can be the process of weaning patients off ventilator support after an extended period of chronic critical illness.

The weaning process involves various regimens of progressive reduction in ventilator support – analogous to athletic or resistance training. But, unlike athletic training, the ICU process is out of the control of patients – who may also be disorientated, confused and suffering short-term memory loss. As a result, they can be prone to distress or panic when breathing support is partially or temporarily withdrawn. As well as contributing to psychological trauma, this can lead to extended ICU stays and poorer long-term outcomes.

Now Dr Charlotte Small and colleagues at the SRMRC are harnessing interactive technology in a bid to make the process more patient friendly through their DELVE system.

“This exciting programme of work has huge potential for patients and their loved ones,” said Dr Small. “By improving understanding of the process of recovery from critical illness – and combining that with the knowledge gained from our research – we aim to enhance clinician decision making and prediction of recovery pathways.”

Dr Small’s previous role as an anaesthetic trainee in the Royal Air Force led her to undertake research and quality improvement work into the management of acute trauma-related pain. She is the chief investigator for a programme of work investigating how interactive technology could benefit the experience and performance of patients during early rehabilitation in ICUs – which includes a feasibility study of the DELVE system.

The project is being funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre – a partnership between the NIHR, the Ministry of Defence, University Hospitals Birmingham NHS Foundation Trust (the Trust which runs QEHB) and the University of Birmingham. The initiative brings both military and civilian trauma surgeons and scientists together to share advanced clinical practice on the battlefield and innovation in medical research to benefit all trauma patients in the NHS at an early stage of injury.