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Central venous saturation was an early and independent predictor of extubation failure and may be a valuable accurate parameter to be included in weaning protocols of difficult-to-wean patients.

Among the general ICU subjects receiving mechanical ventilation, use of an MI-E device during respiratory physiotherapy resulted in a larger amount of airway mucus clearance than respiratory physiotherapy alone. (ClinicalTrials.gov registration NCT03178565.).

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Life support limitation decision making in Brazilian ICUs is predominantly centred on the medical perspective with scarce participation of the family, and consequently several non-coherent medical interventions are observed in patients with life support limitation.

Objective: To determine whether the predictive accuracy of clinical judgment alone can be improved by supplementing it with an objective weaning protocol as a decision support tool. Methods: This was a multicenter prospective cohort study carried out at three medical/surgical ICUs. The study involved all consecutive difficultto-wean ICU patients (failure in the first spontaneous breathing trial [SBT]), on mechanical ventilation (MV) for more than 48 h, admitted between January of 2002 and December of 2005. The patients in the protocol group (PG) were extubated after a T-piece weaning trial and were compared with patients who were otherwise extubated (non-protocol group, NPG). The primary outcome measure was reintubation within 48 h after extubation. Results: We included 731 patients-533 (72.9%) and 198 (27.1%) in the PG and NPG, respectively. The overall reintubation rate was 17.9%. The extubation success rates in the PG and NPG were 86.7% and 69.6%, respectively (p < 0.001). There were no significant differences between the groups in terms of age, gender, severity score, or pre-inclusion time on MV. However, COPD was more common in the NPG than in the PG (44.4% vs. 17.6%; p < 0.001), whereas sepsis and being a post-operative patient were more common in the PG (23.8% vs. 11.6% and 42.4% vs. 26.4%, respectively; p < 0.001 for both). The time on MV after the failure in the first SBT was higher in the PG than in the NPG (9 ± 5 days vs. 7 ± 2 days; p < 0.001). Conclusions: In this sample of difficult-to-wean patients, the use of a weaning protocol improved the decision-making process, decreasing the possibility of extubation failure.Keywords: Ventilator weaning; Ventilation; Ventilators, mechanical. ResumoObjetivo: Determinar se a acurácia preditiva do julgamento clínico isolado pode ser melhorada com o uso suplementar de um protocolo de desmame objetivo como ferramenta de suporte para a tomada de decisão. Métodos: Estudo prospectivo multicêntrico de coorte realizado em três UTIs clínicas/cirúrgicas. Foram incluídos no estudo todos os pacientes de desmame difícil (falha no primeiro teste de ventilação espontânea [TVE]), sob ventilação mecânica (VM) por mais de 48 h, admitidos em uma das UTIs entre janeiro de 2002 e dezembro de 2005. Os pacientes do grupo protocolo (GP) foram extubados após teste de tubo T de acordo com um protocolo de desmame e comparados com o grupo de pacientes extubados sem o uso do protocolo (GNP). O desfecho primário foi a taxa de reintubação em até 48 h após a extubação. Resultados: Foram incluídos 731 pacientes -533 (72,9%) no GP e 198 (27,1%) no GNP. A taxa global de reintubação foi de 17,9%. As taxas de sucesso da extubação no GP e no GNP foram 86,7% e 69,6%, respectivamente (p < 0,001). Não houve diferenças significativas entre os grupos quanto a idade, gênero, escore de gravidade e tempo de VM antes da inclusão. Entretanto, DPOC foi mais frequente no GNP que no GP (44,4% vs. 17,6%; p < 0,001), ao passo que pacientes sépticos e em pós-operatório foram mais comuns no GP (23,8% vs. 1...

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