Weaning from mechanical ventilation

Mancebo, Jordi

doi:10.1183/09031936.96.09091923

Cited by 85 publications

(61 citation statements)

References 83 publications

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“…Among the different ventilatory modes which can be used to wean neonates, PTV is a mode maintaining an inspiratory effort from the patient [13] and thus an exercise of respiratory muscles without excessive increase of V'O 2 as well as work of breathing. Thus, PTV seems to be an interesting ventilatory mode to wean infants with high OCB, as proposed in adults [2,14]. However, no clinical trial to date has confirmed this in neonates.…”

Section: Discussionmentioning

confidence: 99%

Oxygen cost of breathing and weaning process in newborn infants

Rozé¹,

Liet²,

Gournay³

et al. 1997

Eur Respir J

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Newborn infants may have a high oxygen cost of breathing (OCB) at the time of being weaned from mechanical ventilation. We hypothesized that this increase in oxygen consumption (V'O 2 ) could be reduced by using certain weaning ventilatory modes.We designed a study to assess V'O 2 during three weaning ventilatory modes: patient triggered ventilation, synchronous intermittent mandatory ventilation (SIMV) and continuous positive airway pressure in 16 newborn infants before being weaned from mechanical ventilation In seven infants whose OCB was high. V 'O 2 was not significantly different between CV and PTV (8.9±0.6 versus 9.5±0.8, respectively) whereas it tended to increase to 10.8±1.1 mL·min -1 ·kg -1 during SIMV and increased significantly to 11.9±0.8 mL·min -1 ·kg -1 . In the other nine infants whose OCB was normal, no significant variation of V 'O 2 was observed.Patient triggered ventilation was a weaning ventilatory mode that significantly reduced the increase in oxygen consumption observed in infants with a high oxygen cost of breathing, as compared to synchronous intermittent mandatory ventilation or continuous positive airway pressure. Further investigations in newborn infants with a high oxygen cost of breathing should be performed prior to routine use of patient triggered ventilation. Eur Respir J 1997; 10: 2583-2585 Weaning from artificial ventilation is a critical challenge, especially in newborn infants with chronic lung disease. We have previously shown that these newborn infants increase their oxygen consumption (V'O 2 ) at the time of being weaned from mechanical ventilation [1]. This increase is secondary to a high oxygen cost of breathing (OCB) probably related to increased work of breathing, similar to that shown in adult patients [2]. Inspiratory pressure support, used during the weaning process in adult intensive care, may be useful in reducing the work of breathing [2]. Recent data have shown that patient triggered ventilation (PTV) decreases the work of breathing in premature neonates [3], and that PTV can be used as a weaning ventilatory mode [4][5][6][7]. We hypothesized that the increase in V'O 2 observed at the time of weaning in some newborn infants could be reduced by using PTV. We designed a study to assess V'O 2 during PTV as compared to synchronous intermittent mandatory ventilation (SIMV) and continuous positive airway pressure (CPAP) in newborn infants, before being weaned from mechanical ventilation. MethodsThe population was selected to include patients with normal and high OCB. Thus, in this prospective study, we included 16 infants requiring assisted ventilation for either acute respiratory distress (eight infants) or chronic lung disease (eight infants), after informed consent was obtained from the parents. The clinical characteristics, which covered a wide range, were at the time of measurement: gestational age; 33.9±1.0 (range, 28±41) weeks; postnatal age; 18±4 (2-65) days; postconceptional age; 36. 5±1.3 (31.3-48.3) weeks; and weight; 2.3±0.2 (1.4-3.5) kg.

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Section: Discussionmentioning

confidence: 99%

Oxygen cost of breathing and weaning process in newborn infants

Rozé¹,

Liet²,

Gournay³

et al. 1997

Eur Respir J

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“…9,10) A previous study reported oral health problems in 70% of inpatients admitted to acute stage hospitals without full-time dental professionals.…”

Section: Discussionmentioning

confidence: 99%

Activities and Actual Achievements of Respiratory Support Team at Showa University Hospital: Report of Activities in the Year 2012

Ooka

Morita

Takagi

et al. 2013

DMR, Dental Med Res

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“…Weaning can be initiated if some conditions are reached. These conditions are: (i) improvement of the underlying disease; (ii) an adequate gas exchange; (iii) stable hemodynamics; (iv) adequate performance of the respiratory muscles with correct management of respiratory secretions; and (v) no major metabolic and/or electrolytic disturbances 9,10 . The correct management of respiratory secretions has to be evaluated because the patients need to protect their airway and clear the secretions with an effective cough.…”

Section: Weaning Processmentioning

confidence: 99%

“…This is the most common cause for weaning failure [18][19][20][21] . The deterioration in respiratory system mechanics in patients who fail the weaning trial is characterized by an increase in intrinsic positive end-expiratory pressure (PEEP), and inspiratory resistance with a decrease in dynamic lung compliance 22 .…”

Section: Respiratory Pump Failurementioning

confidence: 99%

The Process of Weaning from Mechanical Ventilation

Aguirre-Bermeo¹,

Mancebo²

2016

BRN

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Mechanical ventilation is a common process in intensive care units. The weaning period has to be initiated as soon as possible because a delay in recognition that weaning can begin may prolong the duration of mechanical ventilation unnecessarily. The inappropriate management of weaning could influence outcomes; therefore, patients on weaning require continuous attention and intervention. The main objective of this review is to provide a description of the entire scenario and update on outcomes and common recommendations for the correct management of this complex process. The role of modern ventilator modes and non-invasive mechanical ventilation are discussed. Finally, the description and outcomes of a group of patients who have poor outcomes (prolonged weaning group), the importance of their identification, and suggestions for their general management are also presented. (BRN Rev. 2016;2:185-97)

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Weaning from mechanical ventilation

Cited by 85 publications

References 83 publications

Oxygen cost of breathing and weaning process in newborn infants

Oxygen cost of breathing and weaning process in newborn infants

Activities and Actual Achievements of Respiratory Support Team at Showa University Hospital: Report of Activities in the Year 2012

The Process of Weaning from Mechanical Ventilation

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