TITLE

Our paper 20 years later: how has withdrawal from mechanical ventilation changed?

AUTHOR(S)
Frutos-Vivar, Fernando; Esteban, Andrés
PUB. DATE
October 2014
SOURCE
Intensive Care Medicine;Oct2014, Vol. 40 Issue 10, p1449
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Withdrawal from mechanical ventilation (or weaning) is one of the most common procedures in intensive care units. Almost 20 years ago, we published one of the seminal papers on weaning in which we showed that the best method for withdrawal from mechanical ventilation in difficult-to-wean patients was a once-daily spontaneous breathing trial with a T-piece. Progress has not stood still, and in the intervening years up to the present several other studies, by our group and others, have shaped weaning into an evidence-based technique. The results of these studies have been applied progressively to routine clinical practice. Currently, withdrawal from mechanical ventilation can be summarized as the evaluation of extubation readiness based on the patient's performance during a spontaneous breathing trial. This trial can be performed with a T-piece, which is the most common approach, or with continuous positive airway pressure or low levels of pressure support. Most patients can be disconnected after passing the first spontaneous breathing trial. In patients who fail the first attempt at withdrawal, the use of a once-daily spontaneous breathing trial or a gradual reduction in pressure support are the preferred weaning methods. However, new applications of standard techniques, such as noninvasive positive pressure ventilation, or new methods of mechanical ventilation, such as automatic tube compensation, automated closed-loop systems, and automated knowledge-based weaning systems, can play a role in the management of the patients with difficult or prolonged weaning.
ACCESSION #
98519202

 

Related Articles

  • Managing the apparent and hidden difficulties of weaning from mechanical ventilation. Perren, Andreas; Brochard, Laurent // Intensive Care Medicine;Nov2013, Vol. 39 Issue 11, p1885 

    Background: In anaesthetized patients scheduled for surgery, tracheal intubation is performed with the expectation of subsequent smooth extubation. In critically ill patients, separation from the ventilator is often gradual and the time chosen for extubation may be either delayed or premature....

  • Percutaneous dilatational tracheostomy without fiber optic bronchoscopy-Evaluation of 80 intensive care units cases. Calvachea, José Andrés; Molina García, Rodrigo A.; Trocheza, Adolfo L.; Benitezd, Federico; Flga, Lucía Arroyo // Colombian Journal of Anesthesiology / Revista Colombiana de Anes;jul-sep2013, Vol. 41 Issue 3, p184 

    Background: The development of percutaneous dilatational tracheostomy techniques (PDT) has facilitated the procedure in Intensive Care Units (ICU). Objective: To describe the early intra and post-operative complications in ICU patients requiring percutaneous dilatational tracheostomy using the...

  • Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients. Beijers, Ashley; Roos, Arnout; Bindels, Alexander // Intensive Care Medicine;May2014, Vol. 40 Issue 5, p752 

    This article reports on a study which determined the safety and efficacy of Intellivent-assisted support ventilation (ASV) compared to ASV and other conventional ventilation in patients weaning on a post-anesthesia care unit (PACU). Researchers examined low-risk post-cardiac surgery adults, who...

  • Asynchronies during mechanical ventilation are associated with mortality. Blanch, Lluís; Villagra, Ana; Sales, Bernat; Montanya, Jaume; Lucangelo, Umberto; Luján, Manel; García-Esquirol, Oscar; Chacón, Encarna; Estruga, Anna; Oliva, Joan; Hernández-Abadia, Alberto; Albaiceta, Guillermo; Fernández-Mondejar, Enrique; Fernández, Rafael; Lopez-Aguilar, Josefina; Villar, Jesús; Murias, Gastón; Kacmarek, Robert // Intensive Care Medicine;Apr2015, Vol. 41 Issue 4, p633 

    Purpose: This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV). Methods: Prospective, noninterventional observational study of 50 patients admitted to intensive care unit (ICU) beds equipped with Better Careâ„¢ software throughout MV....

  • Women receive more trials of noninvasive ventilation for acute respiratory failure than men: a nationwide population-based study.  // Critical Care;2011, Vol. 15 Issue 3, p10323 

    The article presents a study which investigates the existence of gender differences in Taiwan and the provision of the types of mechanical ventilation (MV) such as invasive (INV) and noninvasive ventilation (NIV). The study assessed the gender differences using multivariable analyses and...

  • Clinical Outcomes After Unplanned Extubation in a Surgical Intensive Care Population. Lee, Ji-Hyun; Lee, Hyung-Chul; Jeon, Young-Tae; Hwang, Jung-Won; Lee, Hannah; Oh, Hye-Won; Park, Hee-Pyoung // World Journal of Surgery;Jan2014, Vol. 38 Issue 1, p203 

    Background: Clinical outcome after unplanned extubation (UE) in patients admitted to the surgical intensive care unit (SICU) has not been fully investigated. In this study we assessed in-hospital mortality of patients with UE and determined whether UE is a predictor of in-hospital mortality....

  • Can Gastric Tonometry be Used to Determine Weaning Failure? Baysal, Ömer Faruk; Coşkun, Ramazan; Buyukoğlan, Hakan; Sungur, Murat; Güven, Muhammet // Turkish Journal of Medical & Surgical Intensive Care Medicine / ;2010, Issue 3, p55 

    Aim: Despite the advances, weaning from mechanical ventilation is an important problem in the daily operation of intensive care units (ICUs). The aim of this study was to measure the changes in intramucosal pH (pHi) and PCO2 of gastric juice (PiCO2) and to determine the value of these variables...

  • NON-INVASIVE POSITIVE PRESSURE VENTILATION FACILITATES EARLY EXTUBATION IN POST OPERATIVE CARDIAC PATIENTS. Laiq, Nasreen; Khan, Riaz Anwar; Malik, Abdul // JPMI: Journal of Postgraduate Medical Institute;2013, Vol. 27 Issue 4, p361 

    Objectives: To assess the use of NIPPV (non-invasive positive pressure ventilation) during weaning from mechanical ventilation in post-op patients in an ICU and compared this procedure with intermittent mandatory ventilation (IMV) by analyzing cardiac and respiratory parameters and...

  • Ventilation -- how often are we correct? Dennis, D.; Jacob, W.; Van Heerden, P. V. // Anaesthesia & Intensive Care;Jul2012, Vol. 40 Issue 4, p638 

    The article discusses a study which investigated if intensive care clinicians are accurately determining the tidal volumes (Vt) being delivered during mechanical ventilation. The study described the mortality risk associated with either small of high Vt. Study authors emphasized the need to...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics