Clinical management of weaning  from mechanical ventilation

Esteban, Andrés; Alía, Inmaculada

doi:10.1007/s001340050708

Cited by 79 publications

(59 citation statements)

References 20 publications

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“…The RSBI is valid in surgical patients, as well [221]. Analysis of patients failing liberation with RSBIs less than 100 found that most fail due to new problems unrelated to the original process that caused them to be intubated, such as new-onset congestive heart failure, upper airway obstruction, and aspiration [222]. The utility of the RSBI in overdose or poisoned patients has not been studied.…”

Section: Ventilator Liberationmentioning

confidence: 97%

Therapeutic Approach to the Critically Poisoned Patient

Schwarz¹

2016

Critical Care Toxicology

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Section: Ventilator Liberationmentioning

confidence: 97%

Therapeutic Approach to the Critically Poisoned Patient

Schwarz¹

2016

Critical Care Toxicology

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“…With an average of 9 days, weaning took longer in the current study than in the previous study by Esteban and coworkers, who reported a mean weaning duration of 4 days [5] . The list of factors that can lead to weaning failure and prolonged weaning in surgical and medical patients is very long [49] . In neurologic patients, reduced vigilance, lack of defense reflexes, dysphagia, and cerebral dysfunction are observed regularly.…”

Section: Discussionmentioning

confidence: 99%

Discontinuous versus Continuous Weaning in Stroke Patients

Teismann¹,

Oelschläger

Werstler³

et al. 2015

Cerebrovasc Dis

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Background: An increasing number of stroke patients have to be supported by mechanical ventilation in intensive care units (ICU), with a relevant proportion of them requiring gradual withdrawal from a respirator. To date, weaning studies have focused merely on mixed patient groups, COPD patients or patients after cardiac surgery. Therefore, the best weaning strategy for stroke patients remains to be determined. Methods: Here, we designed a prospective randomized controlled study comparing adaptive support ventilation (ASV), a continuous weaning strategy, with biphasic positive airway pressure (BIPAP) in combination with spontaneous breathing trials, a discontinuous technique, in the treatment of stroke patients. The primary endpoint was the duration of the weaning process. Results: Only the 40 (out of 54) patients failing in an initial spontaneous breathing trial (T-piece test) were included into the study; the failure proportion is considerably larger compared to previous studies. Eligible patients were pseudo-randomly assigned to one of the two weaning groups. Both groups did not differ regarding age, gender, and severity of stroke. The results showed that the median weaning duration was 10.7 days (±SD 7.0) in the discontinuous weaning group, and 8 days (±SD 4.5) in the continuous weaning group (p < 0.05). Conclusions: To the best of our knowledge, this is the first clinical study to show that continuous weaning is significantly more effective compared to discontinuous weaning in mechanically ventilated stroke patients. We suppose that the reason for the superiority of continuous weaning using ASV as well as the bad performance of our patients in the 2 h T-piece test is caused by the patients' compliance. Compared to patients on surgical and medical ICUs, neurological patients more often suffer from reduced vigilance, lack of adverse-effects reflexes, dysphagia, and cerebral dysfunction. Therefore, stroke patients may profit from a more gradual withdrawal of weaning.

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“…10 The rapid shallow breathing index, respiratory rate/V T measured during the first minute of spontaneous breathing (f/Vt s -1 l -1 ), is the most validated. 11,12 However, assessment of respiration during a formal spontaneous breathing trial (SBT) appears to be the best predictor of successful extubation and therefore of weaning success.…”

Section: Can Any Criteria Predict Eventual Weaning Success?mentioning

confidence: 99%