Which Patients Need a Weaning Technique

Benito, S.; Vallverdú, I.; Mancebo, Jordi

doi:10.1007/978-3-642-84554-3_24

Cited by 10 publications

(3 citation statements)

References 33 publications

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“…The median total duration ofventilation (total number of hours over all cycles excluding interruptions) was 27 hours per patient (range 2-274). For the initial cycle ofventilatory treatment the following median settings of the iron lung were used: (a) negative pressure -48 (range -40 to -60) cm H20; (b) positive pressure +15 (range +10 to + 20 cm H2O; (c) breath rate 15 (range [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] breaths/min; On admission bradypnoea was observed (. 10 breaths/min) in 56.7% of the patients and the iron lung was set to a respiratory rate of 15 breaths/min with TI/TTOT of 30% in these patients.…”

Section: Results Patientsmentioning

confidence: 99%

Intermittent negative pressure ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency.

Corrado

Paola

Gorini

et al. 1996

Thorax

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Results -There were 45 treatment failures (30%) and 36 deaths (24%). Nine patients (6%) required intubation because of lack of airway control. The median total duration of ventilation was 27 hours per patient (range 2-274). The 105 successfully treated cases recovered consciousness after a median of four hours (range 1-90) of continuous ventilatory treatment and were discharged after 12.1 (9.0) days. Conclusions -These results show that, in patients with acute on chronic respiratory failure and hypoxic hypercapnic coma, the iron lung resulted in a high rate ofsuccess. As this study has the typical limitations of all retrospective and uncontrolled studies, the results need to be formally confirmed by controlled prospective studies. Confirmation of these results could widen the range of application of non-invasive ventilatory techniques.

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Section: Results Patientsmentioning

confidence: 99%

Intermittent negative pressure ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency.

Corrado

Paola

Gorini

et al. 1996

Thorax

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“…Our results confirm these data by demonstrating diminished alveolar hypoventilation in response to NIV following extubation. From a clinical viewpoint, the value of NIV as an early extubation and weaning technique can also be justified by the weaning difficulties observed in 20 to 80% of patients, depending on the series and the underlying disease (7,8), and by the capacity for ventilator dependency of approximately 25 to 45% of these patients for more than 21 d (9) regardless of the weaning technique used (15)(16)(17). These difficulties in weaning therefore require prolonged ETMV and hospitalization, with consequently increased morbidity and mortality (9-11) and inevitable major human as well as economic repercussions (12,32).…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Ventilation as a Systematic Extubation and Weaning Technique in Acute-on-Chronic Respiratory Failure

Girault

Daudenthun

Chevron

et al. 1999

Am J Respir Crit Care Med

307

134

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Prolonged duration of endotracheal mechanical ventilation (ETMV) is associated with an increased morbidity and mortality in intensive care unit (ICU) patients. The aim of this study was to assess the usefulness of noninvasive ventilation (NIV) as a systematic extubation and weaning technique to reduce the duration of ETMV in acute-on-chronic respiratory failure (ACRF). Among 53 consecutively intubated patients admitted for ACRF, we conducted a prospective, randomized controlled trial of weaning in 33 patients who failed a 2-h T-piece weaning trial (2 h-WT) although they met simple criteria for weaning. Conventional invasive pressure support ventilation (IPSV) was used as the control weaning technique in 16 patients (IPSV group), and NIV was applied immediately after extubation in 17 patients (NIV group). The two weaning groups were similar for type of chronic respiratory failure (CRF), pulmonary function data, age, Simplified Acute Physiology Score (SAPS II), and severity of ACRF on admission. The characteristics of the two groups were also similar at randomization. In the IPSV group, 12 of 16 patients (75%) were successfully weaned and extubated, versus 13 of 17 (76.5%) in the NIV group (p = NS). NIV like IPSV significantly and similarly improved gas exchange in relation to that achieved during 2 h-WT (p < 0.05). The duration of ETMV was significantly shorter in the NIV (4.56 +/- 1.85 d) than in the IPSV group (7.69 +/- 3.79 d) (p = 0. 004). NIV also reduced the mean period of daily ventilatory support, but increased the total duration of ventilatory support related to weaning (3.46 +/- 1.42 d, versus 11.54 +/- 5.24 d with NIV; p = 0. 0001). Most patients in the IPSV group developed complications related to ETMV and/or the weaning process, but the difference was not significant (nine of 16 versus six of 17). The durations of ICU and hospital stays and the 3-mo survival were similar in the two groups. In conclusion, NIV permits earlier removal of the endotracheal tube than with conventional IPSV, and reduces the duration of daily ventilatory support without increasing the risk of weaning failures. NIV should be considered as a new and useful systematic approach to weaning in patients with ACRF who are difficult to wean.

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“…Indices to predict the outcome of weaning trials may differ depending on the characteristics of the patients. Thus, those with neurological diseases may behave in a different way from COPD patients [68]. The same may occur with the different weaning techniques, and it can eventually be shown that a particular technique is best suited for a specific disease [69].…”

Section: Discussionmentioning

confidence: 99%

Weaning from mechanical ventilation

Mancebo

1996

Eur Respir J

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W We ea an ni in ng g f fr ro om m m me ec ch ha an ni ic ca al l v ve en nt ti il la at ti io on n J. ManceboWeaning from mechanical ventilation. J. Mancebo. ERS Journals Ltd 1996. ABSTRACT: Weaning from mechanical ventilation is a period of transition from total ventilatory support to spontaneous breathing. It represents a relevant clinical problem because as many as 25% of intubated and mechanically-ventilated critically ill patients will need a progressive withdrawal from artificial ventilatory support.From a clinical standpoint, it is very important to recognize as soon as possible when a patient is ready to be weaned. Accordingly, a daily routine follow-up should be performed in every patient in order to verify whether patients meet clinical criteria to be disconnected from the ventilator. Several physiological indices have been used to predict the outcome of weaning trials. However, an adequate clinical tolerance to spontaneous breathing during a 2 h T-piece trial is very useful to predict a successful extubation.A number of physiopathological mechanisms explain why some patients fail the weaning trials; particularly important from a clinical point of view are those related to respiratory pump failure and cardiovascular instability, which are usually accompanied by an abnormal gas exchange.Different ventilatory techniques can be used to wean these patients from mechanical ventilation. Up to now, the most efficient techniques seem to be pressure support ventilation and once daily trials of T-piece interspersed with conventional volume assist-control ventilation.Finally, knowledge-based system applied to modern microprocessor mechanical ventilators can help in the process of weaning by automatically reducing the ventilatory assistance and indicating the optimal time to perform extubation.

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Which Patients Need a Weaning Technique

Cited by 10 publications

References 33 publications

Intermittent negative pressure ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency.

Intermittent negative pressure ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency.

Noninvasive Ventilation as a Systematic Extubation and Weaning Technique in Acute-on-Chronic Respiratory Failure

Weaning from mechanical ventilation

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