Weaning from mechanical ventilation

Boles, Jean-Michel; Bion, Julian; Connors, Alfred F.; Herridge, Margaret S.; Marsh, Brian; Mélot, Christian; Pearl, Ronald G.; Silverman, Henry; Stanchina, Michael; Vieillard‐Baron, Antoine; Welte, Tobias

doi:10.1183/09031936.00010206

Cited by 1,545 publications

(1,632 citation statements)

References 226 publications

Supporting

Mentioning

1,407

Contrasting

Unclassified

194

Order By: Relevance

“…Compared with the previous literature, the lower weaning success rate in our study is probably related to the heterogeneity of our study population and to the specific PMV nature of our subjects. 9 We have confirmed that patients in a protected environment present a low mortality risk with a weaning rate of Ͻ 50%. We have also shown that tracheostomy and stay in a chronic ventilator facility do not affect mortality, weaning, or their timing.…”

Section: Discussionsupporting

confidence: 62%

“…1 Indeed, this condition may increase risk of early mortality 5,6 and late pulmonary complications, 7 involving increased health costs. 8 Patients needing prolonged mechanical ventilation (PMV) 9 may require transfer to a protected environment such as a chronic ventilator facility, 3,10 which studies have shown can offer some clinical and financial advantages over a prolonged ICU stay. 3,11,12 In particular, patients may receive a prompt and dedicated physiotherapy rehabilitation program in chronic ventilator facilities, 1,3,13 and transfer from an ICU to a chronic ventilator facility substantially improved patients' ambulation and activities of daily life irrespective of the underlying pathophysiology, avoiding unnecessary immobilization 14 . To date, the role of comprehensive rehabilitation in critically ill adults still remains controversial 13 or not fully established 15 : patients who have survived a recent acute respiratory failure (ARF) event can benefit from an individually tailored physiotherapy rehabilitation program that improves clinical indices, respiratory and peripheral muscle strength, activities of daily life, exercise tolerance, and disability scores.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Vitacca¹,

Paneroni²,

Peroni

et al. 2014

Respir Care

View full text Add to dashboard Cite

BACKGROUND:The aim of this study was to analyze the effects of a multidisciplinary program carried out in a chronic ventilator facility on disability, autonomy, and nursing needs of patients after a prolonged ICU stay. Secondary outcome measures were survival, weaning rate, chronic ventilator facility stay, and discharge destination. METHODS: Multidisciplinary assessment, clinical stabilization, weaning attempts, and a new Disabled Patients Autonomy Planning tool to assess daily care needs were investigated in 240 subjects in a chronic ventilator facility (52 subjects after cardiovascular surgery, 60 subjects with acute respiratory failure, 71 subjects with COPD, and 57 subjects with neurological disease). RESULTS: At admission, nursing needs, disability, and autonomy differed according to diagnosis (P < .001); weaned subjects had greater nursing needs (P < .001) and disability (P ‫؍‬ .0014) than unweaned subjects. During the stay, 13.8% of the subjects died irrespective of diagnosis (P ‫؍‬ .12); 47% (P < .001) were weaned with significant differences (P <.007) by diagnosis. In the 207 surviving subjects, nursing needs increased as disability increased (r ‫؍‬ 0.59, P < .001) and autonomy decreased (r ‫؍‬ ؊0.66, P < .001); disability and autonomy were interrelated (r ‫؍‬ 0.61, P < .001). Oxygen saturation, hypercapnia, dyspnea, disability, autonomy, and nursing needs significantly improved (all, P < .001). Fifty-nine percent of the subjects were discharged home. Subjects discharged to nursing homes presented mainly neurological diseases, being more disabled and less autonomous, with higher nursing needs (all, P < .04). Mechanical ventilation use and tracheostomy increased the probability of being discharged to a nursing home (odds ratio [OR] of 1.84, P ‫؍‬ .04; OR 2.47, P ‫؍‬ .003, respectively). Mortality was higher in subjects who were ventilated (OR 8.44, P < .001), male (OR 2.64, P ‫؍‬ .01), elderly (P < .001), or malnourished (P ‫؍‬ .01) and in subjects with low autonomy (P < .001), greater nursing needs (P ‫؍‬ .002), and more severe disabilities (P ‫؍‬ .04). CONCLUSIONS: A specialized tailored multidisciplinary program in subjects after an ICU stay contributed to recovery from disability, autonomy, and fewer nursing needs irrespective of diagnosis. Subjects discharged to a nursing home were the most severely disabled.

show abstract

Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Vitacca¹,

Paneroni²,

Peroni

et al. 2014

Respir Care

View full text Add to dashboard Cite

show abstract

“…According to Coplin et al 7 , delayed extubation was associated with a statistically signifi cant increase in mortality (RR for death 2.2, 95% CI: 1.0-4.7). Boles et al 1 have proposed the early investigation of weaning capacity to avoid its delay.…”

Section: Discussionmentioning

confidence: 99%

“…In this context, a predictor, such as the rapid shallow breathing index (RSBI), is initially used as screening and if the result is positive for weaning success, a spontaneous breathing trial (SBT) is started. If the patient passes this test, MV is discontinued and followed by extubation 1 . The problem is that, despite all systematization of the weaning process, backed by different studies that establish the various steps of this process, the average rate of weaning failure is 30%, which is associated with increased morbidity and mortality [1][2][3][4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

“…If the patient passes this test, MV is discontinued and followed by extubation 1 . The problem is that, despite all systematization of the weaning process, backed by different studies that establish the various steps of this process, the average rate of weaning failure is 30%, which is associated with increased morbidity and mortality [1][2][3][4][5][6][7] . According to Epstein et al 6 , weaning failure, particularly extubation failure, is associated with 43% mortality compared to 12% among those with weaning success.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Frequência respiratória como preditor de falha de desmame da ventilação mecânica

Lima¹

2013

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

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.

show abstract

Early vs Late Tracheotomy for Prevention of Pneumonia in Mechanically Ventilated Adult ICU Patients

Terragni¹,

Antonelli²,

Fumagalli³

et al. 2010

JAMA

457

353

View full text Add to dashboard Cite

show abstract

Weaning from mechanical ventilation

Cited by 1,545 publications

References 226 publications

Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Frequência respiratória como preditor de falha de desmame da ventilação mecânica

Early vs Late Tracheotomy for Prevention of Pneumonia in Mechanically Ventilated Adult ICU Patients

Contact Info

Product

Resources

About