Over the last two years of the pandemic, more people than ever have experienced extreme difficulty breathing, requiring mechanical ventilation (intubation) in critical care units across the world. A mechanical ventilator is a machine that helps patients breathe when they cannot breathe on their own due to critical illness, such as COVID-19, or surgery. The machine is connected to a breathing tube that is inserted into the patient’s trachea. The process of intubating (inserting the tube) and extubating (removing the tube) is very complex, and anyone requiring ventilation will require months of recovery and rehabilitation to learn how to swallow, eat, talk and breathe again. Currently, there is no patient monitoring equipment to help physicians decide the best time to remove a patient from a ventilator to improve their outcomes, but that may be just about to change.

The Ottawa Hospital (Ontario, Canada) has become the first hospital in the world to evaluate an innovative medical device that uses artificial intelligence (AI) to predict when critically ill patients are ready to breathe on their own. Over the last 13 years, the team that developed the device has made major progress in using complex mathematics, AI and routinely collected vital sign data to predict when patients are ready to be extubated. The device, called the Extubation Advisor, constantly monitors and analyzes a patient’s vital signs, including blood pressure, oxygen levels, breathing rhythms and heart rate during their ventilation. Then, it uses AI to provide doctors with a specific read of when the patient can be safely removed from the ventilator.

This is the first time that real-time predictive analytics based on this type of high-frequency data is being used and evaluated at the bedside. The system was used for three months at the bedside of ventilated patients in The Ottawa Hospital’s Intensive Care Unit (ICU), with permission from their families. After the successful initial evaluation, the metrics are looking promising, and the feedback received from physicians was very positive. The team hopes that the device will help improve patient safety and outcomes in the near future. The team’s next steps include a randomized controlled trial. With each milestone, they are one step closer to transforming care for some of the sickest patients treated at hospitals.

“Currently, one in every seven ICU patients experiences extubation failure. Prolonged ventilation harms patients, and early extubation requiring reintubation can be a devastating blow to their recovery,” said Dr. Andrew Seely, a critical care physician, thoracic surgeon and scientist at The Ottawa Hospital, who developed the device. “We’ve developed the first medical device to offer extubation decision support, which we believe will help standardize and improve care.” 

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