Use of a Daily Wean Screen and Weaning Protocol for Mechanically Ventilated Patients in a Multi-Disciplinary Tertiary Critical Care Unit

Wood, Kenneth E.; Flaten, Anne; Reedy, Jeremiah S.; Coursin, Douglas B.

doi:10.1097/00003246-199901001-00233

Cited by 6 publications

(3 citation statements)

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“…Entry criteria for the weaning trial were as follows: positive end expiratory pressure ≤ 5 cmH 2 O, partial arterial oxygen tension (PaO 2 )/fractional inspired oxygen concentration (FiO 2 ) ≥ 200, the resolution of (or significant improvement in) the underlying condition requiring mechanical ventilation, hemodynamic stability, an adequate neurological status, an absence of fever, a presence of cough reflex when on a passing suction catheter, an intact gag reflex, and an absence of vasopressor or sedative infusions drips. Dopamine < 5 μg/kg per min was allowed, as were intermittent doses of sedatives [6]. The criteria for tolerating weaning trials were PaO 2 ≥ 60 mmHg or arterial oxygen saturation ≥ 90%, or FiO 2 ≤ 0.4–0.5, PaCO 2 increase ≤ 10 mmHg or pH decrease < 0.1, systolic blood pressure ≥ 90 mmHg or ≤ 180 mmHg with any increase or decrease ≤ 20%, heart rate ≥ 50 beats/min or ≤ 140 beats/min with any increase or decrease ≤ 20%, respiratory rate ≤ 35 breaths/min, and no sign of excessive respiratory work (absence of thoracoab-dominal paradox, respiratory alternans or accessory respiratory muscle action).…”

Section: Methodsmentioning

confidence: 99%

The effects of different weaning modes on the endocrine stress response

et al. 2003

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IntroductionIntubation and mechanical ventilation are safe and effective treatments for critically ill patients with respiratory failure [1]. However, while unnecessary prolongation of mechanical ventilation increases the risk of complications, including bronchopulmonary infections, barotrauma, and oxygen toxicity, its premature discontinuation may also increase morbidity and mortality. Intensive care can indeed be prolonged if reintubation is needed [2,3]. 'Weaning' is the withdrawal of mechanical ventilatory support, although the term 'liberation' may be more appropriate [4]. Selection of the most appropriate mode for weaning can be difficult [5].The effect of weaning on the stress response in critically ill patients is uncertain, as are the effects of different weaning modes. The aim of the present study was to compare changes in plasma concentrations of insulin, cortisol and glucose, and in urine vanilmandelic acid (VMA) during weaning and after extubation, using the three different modes of pressure support (PS) ventilation, continuous positive airway pressure (CPAP) and T-piece, in intensive care patients. AbstractIntroduction The aim of the present study was to investigate the effects of the stress response on plasma insulin, cortisol, glucose, and urinary vanilmandelic acid during weaning and after extubation, using pressure support (PS), continuous positive airway pressure (CPAP) and T-piece modes. Methods Sixty patients were randomly divided into three groups (n = 20). The PS group received FiO 2 ≤ 0.4, PS ≤ 10 cmH 2 O, and positive end expiratory pressure ≤ 5 cmH 2 O for 2 hours. The CPAP group was given FiO 2 ≤ 0.4 and CPAP ≤ 5 cmH 2 O for 2 hours. The T-piece group (group T) received 4 l/min oxygen via a T-piece for 2 hours. After 1 hour and 2 hours in their respective weaning modes, blood and urine samples were taken for insulin, cortisol, glucose and vanilmandelic acid measurements. Forty-eight hours after extubation, blood and urine samples were again taken. Results Plasma insulin was greater in group T than in the PS and CPAP groups (P < 0.01 and P < 0.01). The plasma cortisol concentration was greater in group T than in group PS during weaning (P < 0.05) and after extubation (P < 0.05). Blood glucose concentrations were greater in group T than in the other groups (both P < 0.01) both during weaning and post extubation. Urine vanilmandelic acid was greater in group T than in the other groups during weaning and after extubation (both P < 0.001). Conclusion Weaning via the T-piece caused a greater stress response than the PS and CPAP modes.

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Section: Methodsmentioning

confidence: 99%

The effects of different weaning modes on the endocrine stress response

et al. 2003

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“…1), 50% fewer complications, and a reduction in the cost of ICU stay by $5,000 per patient. Subsequent implementation of this protocol in 530 patients at another large medical center was associated with a similar reintubation rate (6%) and no increased risk of mortality [21]. Simultaneous to our study, Kollef and colleagues [22] were conducting another RCT (n=357) of protocol-directed versus physician-directed weaning in four ICUs (two medical and two surgical).…”

Section: Liberating Patients From Mechanical Ventilationmentioning

confidence: 52%

“…• Successful completion of a 2 hour SBT indicates an 85 to 90% chance of successfully staying off the mechanical ventilation for 48 hours [21]. RR = respiratory rate; HR = heart rate; FiO2 = fraction of inspired oxygen; SpO2 =oxygen saturation as obtained via a pulse oximeter or an arterial blood gas.…”

Section: What Does It Mean If a Patient Passes An Sbt?mentioning

confidence: 99%