Protocol-directed weaning from mechanical ventilation: clinical outcome in patients randomized for a 30-min or 120-min trial with pressure support ventilation

Perren, Andréas; Domenighetti, Guido; S, Mauri; Genini, Franco; Vizzardi, Nicoletta

doi:10.1007/s00134-002-1353-z

Cited by 140 publications

(90 citation statements)

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“…Extubation failure (EF) was associated with higher mortality rate (70%). Several studies show that EF is associated with increased mortality 2,3,6,[18][19][20] . According to Epstein et al 6 , the mortality rate in patients with EF was 43% compared to 12% among those with weaning success (p < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

Frequência respiratória como preditor de falha de desmame da ventilação mecânica

Lima¹

2013

Rev. Bras. Anestesiol.

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Background and objective: There is not an ideal predictor of weaning from mechanical ventilation (MV). In a large meta-analysis, despite methodological limitations, respiratory rate (RR) was considered a promising predictor. The aim of this study was to evaluate RR as a predictor of weaning failure from MV. Methods: We prospectively evaluated 166 patients scheduled for weaning from MV. RR and other essential criteria for weaning were evaluated at an early stage of screening. Patients who met the essential screening criteria for weaning underwent spontaneous breathing trial. RR was compared with the following outcomes: weaning success/failure or extubation failure. Results: Weaning success was present in 76.5% and weaning failure in 17.5% of patients. There were 6% of reintubations. The predictive power for RR weaning failure, RR best cut-off point > 24 breaths per minute (rpm), was: sensitivity 100%, specifi city 85%, and accuracy 88% (ROC curve, p < 0.0001). Of the patients with weaning failure, 100% were identifi ed by RR during screening (RR cut-off > 24 rpm). There were 15% false positives, weaning successes with RR > 24 rpm. Conclusion: RR was an effective predictor of weaning failure. The best cut-off point was RR > 24 rpm, which differed from those reported in the literature (35 and 38 rpm). Only 6% of patients were reintubated, but RR or other weaning criteria did not identify them.

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Section: Discussionmentioning

confidence: 99%

Frequência respiratória como preditor de falha de desmame da ventilação mecânica

Lima¹

2013

Rev. Bras. Anestesiol.

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“…Nesses estudos, fatores preditivos de desmame foram usados como critérios para a realização do TRE. O desmame só foi iniciado quando o índice de respiração rápida e superficial não excedeu 105 ciclos/min/L 19 , ou se após 3-5 minutos de ventilação espontânea o paciente tinha pelo menos dois dos seguintes critérios: frequência respiratória inferior a 35 respiração/ minuto, pressão inspiratória máxima abaixo de -20 cmH 2 O ou volume corrente acima de 5 mL/kg do peso predito 21 . É importante salientar que na rotina da UTI, onde o presente estudo foi realizado, não estão protocolados critérios para a realização do TRE, o que pode ter influenciado nas incidências do desmame ventilatório, principalmente no grupo desmame simples como constatado anteriormente.…”

Section: Artigo Originalunclassified

Incidência e fatores associados ao desmame simples, difícil e prolongado em uma unidade de terapia intensiva

2016

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“…2 Weaning accounts for 41% and 60% of the total ventilatory time in mixed, medicalsurgical ICU populations and in populations with chronic obstructive pulmonary disease (COPD), respectively. 3 Over the past decade, clinical investigations have focused on strategies to limit the duration of ventilation, for example, early identification of patients who are likely to be weaned, [4][5][6] tests of readiness to resume spontaneous breathing trials (SBTs), [7][8][9] and strategies to reduce support in patients who fail a SBT. [10][11][12] Several modes and techniques have been used to liberate critically ill adults from invasive mechanical ventilation.…”

Section: Résumémentioning

confidence: 99%

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Burns

Lellouche²,

Slutsky

et al. 2009

Can J Anesth/J Can Anesth

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Purpose To determine the stated practices of clinicians in weaning critically ill adults from invasive ventilation. Methods We conducted a cross-sectional, self-administered postal survey of Critical Care physicians and respiratory therapists (RTs) in leadership roles at Canadian teaching hospitals. We identified respondents using electronic mail and telephone correspondence. We used rigorous survey methodology to develop, test, and administer the questionnaire.Results One hundred ten of 162 (67.9%) clinicians returned the survey with 99 respondents (55 physicians and 44 RTs) completing it either in-part or in-full. Approximately 95% of respondents acknowledged ever performing spontaneous breathing trials (SBTs) in clinical practice. Of these, 95.6% and 32% of respondents reported conducting daily and twice-daily screening to identify SBT candidates, at least sometimes. The three most common techniques to conduct SBTs included; pressure support (PS) with positive end-expiratory pressure (70.8%), continuous positive airway pressure (35.7%), and use of a T-piece (25.0%). PS ventilation was the weaning strategy used most frequently before SBTs. Most respondents (57.1%) considered continuous infusion of sedative-hypnotics to be a relative contraindication to tracheal extubation. However, concurrent administration of low dose vasopressors, inotropes, and analgesic boluses, or continuous analgesic infusions were considered acceptable amongst 60.8%, 73.2%, 78.4% -009-9124-8 and 58.8% of respondents, respectively. We did not observe regional variation in whether clinicians ever perform SBTs, the ventilatory modes used prior to an SBT nor in the use of PS and SBTs during the weaning process. Conclusions Pressure support and SBTs are common features of weaning in Canadian teaching hospitals. Compared to the published literature, our survey suggests that weaning practices have evolved over time and that practice variation may be greater on an international level compared to a national level.123 Can J Anesth/J Can Anesth (2009) 56:567-576 DOI 10.1007/s12630 RésuméObjectif De´terminer les pratiques de´clare´es des cliniciens concernant le sevrage des patients adultes gravement malades de la ventilation invasive. Méthode Nous avons re´alise´un sondage transversal, auto-administre´et envoye´par courrier aupre`s des me´decins des soins critiques et des inhalothe´rapeutes occupant des positions de leadership dans les hôpitaux d'enseignement canadiens. Nous avons identifie´les re´pondants a`l'aide de correspondance par courrier e´lectronique et par te´le´phone. Nous avons utilise´une me´thodologie de sondage rigoureuse afin d'e´laborer, de tester et d'administrer le questionnaire. Résultats Sur un total de 162 cliniciens, 110 (67,9%) ont renvoye´le questionnaire; 99 re´pondants (55 me´decins et 44 inhalothe´rapeutes) ont comple´te´le questionnaire en entier ou en partie. Environ 95 % des re´pondants ont reconnu qu'ils re´alisaient des tests de ventilation spontane´e (TVS) dans leur pratique clinique. Parmi ceux-ci, 9...

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Protocol-directed weaning from mechanical ventilation: clinical outcome in patients randomized for a 30-min or 120-min trial with pressure support ventilation

Abstract: An SBT with PSV of 7 cmH(2)O lasting 30 min is equally effective in recognizing the successfully extubated patients as a 120-min trial.

Cited by 140 publications

References 20 publications

Frequência respiratória como preditor de falha de desmame da ventilação mecânica

Frequência respiratória como preditor de falha de desmame da ventilação mecânica

Incidência e fatores associados ao desmame simples, difícil e prolongado em uma unidade de terapia intensiva

Weaning critically ill adults from invasive mechanical ventilation: a national survey

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