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Critical Care
Published in: Critical Care 4/2008

01-08-2008 | Review

Clinical review: Liberation from mechanical ventilation

Authors: Mohamad F El-Khatib, Pierre Bou-Khalil

Published in: Critical Care | Issue 4/2008

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Abstract

Mechanical ventilation is the defining event of intensive care unit (ICU) management. Although it is a life saving intervention in patients with acute respiratory failure and other disease entities, a major goal of critical care clinicians should be to liberate patients from mechanical ventilation as early as possible to avoid the multitude of complications and risks associated with prolonged unnecessary mechanical ventilation, including ventilator induced lung injury, ventilator associated pneumonia, increased length of ICU and hospital stay, and increased cost of care delivery. This review highlights the recent developments in assessing and testing for readiness of liberation from mechanical ventilation, the etiology of weaning failure, the value of weaning protocols, and a simple practical approach for liberation from mechanical ventilation.
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Literature
1.
Hall JB, Wood LDH: Liberation of the patient from mechanical ventilation. JAMA. 1987, 257: 1621-1628. 10.1001/jama.257.12.1621.PubMed
2.
Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, Gasparetto A, Lemaire F: Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med. 1994, 150: 896-903.PubMed
3.
Esteban A, Furtos F, Tobin MJ, Alia I, Solsona JF, Vallverdu I, Fernandez R, de la Cal MA, Benito S, Tomas R, Carriedo D, Macias S, Blanco J: A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med. 1995, 332: 345-350. 10.1056/NEJM199502093320601.PubMed
4.
Esteban A, Alia I, Gordo F, Fernandez R, Solsona JF, Vallverdu I, Macia S, Allegue JM, Blanco J, Carriedo D, Leon M, de la Cal MA, Taboada F, Gonzalez de Velasco J, Palazon E, Carizosa F, Tomas R, Suarez J, Goldwasser RS: Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1997, 156: 459-465.PubMed
5.
Esteban A, Alia I, Tobin MJ, Gil A, Gordo F, Vallverdu I, Blanch L, Bonet A, Vazquez A, de Pablo R, Torres A, de la Cal MA, Macias S: Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1999, 159: 512-518.PubMed
6.
Vallverdu I, Calaf N, Subirana M, Net A, Benitto S, Mancebo J: Clinical characteristics, respiratory functional parameters, and outcome of two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med. 1998, 158: 1855-1862.PubMed
7.
Esteban A, Alia I, Ibanez J, Benito S, Tobin MJ: Modes of mechanical ventilation and weaning: a national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest. 1994, 106: 1188-1193. 10.1378/chest.106.4.1188.PubMed
8.
Nevins ML, Epstein SK: Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. Chest. 2001, 119: 1840-1845. 10.1378/chest.119.6.1840.PubMed
9.
Stroetz RW, Hubmayr RD: Tidal volume maintenance during weaning with pressure support. Am J Respir Crit Care Med. 1995, 152: 1034-1040.PubMed
10.
Afessa B, Hogans L, Murphy R: Predicting 3-day and 7-day outcomes of weaning from mechanical ventilation. Chest. 1999, 116: 456-461. 10.1378/chest.116.2.456.PubMed
11.
MacIntyre NR, Cook DJ, Ely EW, Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinborn DJ: Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College for Critical Care Medicine. Chest. 2001, 120: 375S-395S. 10.1378/chest.120.6_suppl.375S.PubMed
12.
Conti G, Montini L, Pennisi MA, Cavaliere F, Arcangeli A, Bocci MG, Proietti R, Antonelli M: A prospective, blinded evaluation of indexes proposed to predict weaning from mechanical ventilation. Intensive Care Med. 2004, 30: 830-836. 10.1007/s00134-004-2230-8.PubMed
13.
Epstein SK: Weaning parameters. Respir Care Clin N Am. 2000, 6: 253-301. 10.1016/S1078-5337(05)70070-8.PubMed
14.
Meade M, Guyatt G, Sinuff T, Griffith L, Hand L, Toprani G, Cook D: Trials comparing alternative weaning modes and discontinuation assessments. Chest. 2001, 120: 425S-437S. 10.1378/chest.120.6_suppl.425S.PubMed
15.
El-Khatib MF, Jamaleddine G, Khoury A, Obeid M: Effect of continuous positive airway pressure on the rapid shallow breathing index in patients following cardiac surgery. Chest. 2002, 121: 475-479. 10.1378/chest.121.2.475.PubMed
16.
El-Khatib MF, Zeinelddine S, Jamaleddine G: The effect of pressure support ventilation and positive end expiratory pressure on the rapid shallow breathing index. Intensive Care Med. 2008, 34: 505-510. 10.1007/s00134-007-0939-x.PubMed
17.
Sahn SA, Lakshminaraya S: Bedside criteria for discontinuation of mechanical ventilation. Chest. 1973, 63: 1002-1005. 10.1378/chest.63.6.1002.PubMed
18.
Yang KL, Tobin MJ: A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991, 324: 1445-1450.PubMed
19.
Chatila W, Jacob B, Guaglionone D, Manthous CA: The unassisted respiratory rate:tidal volume ratio accurately predicts weaning outcome. Am J Med. 1996, 101: 61-67. 10.1016/S0002-9343(96)00064-2.PubMed
20.
Jacob B, Chatila W, Manthous CA: The unassisted respiratory rate/tidal volume ratio accurately predicts weaning outcome in post-operative patients. Crit Care Med. 1996, 25: 253-7. 10.1097/00003246-199702000-00010.
21.
Martinez A, Seymour C, Nam M: Minute ventilation recovery time: a predictor of extubation outcome. Chest. 2003, 123: 1214-1221. 10.1378/chest.123.4.1214.PubMed
22.
Trwit JD, Marini JJ: Validation of a technique to assess maximal inspiratory pressure in poorly cooperative patients. Chest. 1992, 102: 1216-1219. 10.1378/chest.102.4.1216.
23.
Bruton A: A pilot study to investigate any relationship between sustained maximal inspiratory pressure and extubation outcome. Heart Lung. 2002, 31: 141-149. 10.1067/mhl.2002.122840.PubMed
24.
Holliday JE, Hyers TM: The reduction of weaning time from mechanical ventilation using tidal volume and relaxation feedback. Am Rev Respir Dis. 1990, 141: 1214-1220.PubMed
25.
MacIntyre NR: Weaning from mechanical ventilatory support: volume-assisting intermittent breaths versus pressure-assisting every breaths. Respir Care. 1988, 33: 121-125.
26.
Engoren M: Approximate entropy of respiratory rate and tidal volume during weaning from mechanical ventilation. Crit Care Med. 1998, 26: 1817-1823.PubMed
27.
El-Khatib MF, Jamaleddine G, Soubra R, Muallem M: Pattern of spontaneous breathing: potential marker for weaning outcome. Spontaneous breathing pattern and weaning from mechanical ventilation. Intensive Care Med. 2001, 27: 52-58. 10.1007/s001340000758.PubMed
28.
DeHaven CB, Kirton OC, Morgan JP, Hart AM, Shatz DV, Civetta JM: Breathing measurement reduces false-negative classification of tachypneic preextubation trial failures. Crit Care Med. 1996, 24: 976-980. 10.1097/00003246-199606000-00017.PubMed
29.
Kacmarek RM: Point of view: pressure support. Respir Care. 1989, 34: 136-138.
30.
Tobin MJ, Perez W, Guenther SM, Semmes BJ, Mador MJ, Allen SJ, Lodato RF, Dantzker DR: The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dev. 1986, 134: 1111-8.
31.
Nava S, Zanotti E, Rubini F: Weaning and outcome from mechanical ventilation. Monaldi Arch Chest Dis. 1994, 49: 530-532.PubMed
32.
Mergoni M, Costa A, Primavera S, Salvadori A, Saccani A, Zuccoli P: Assessment of various new predictive parameters of the outcome of mechanical ventilation weaning. Minerva Anestesiol. 1996, 62: 153-64.PubMed
33.
Vassilakopoulos T, Zakynthinos S, Roussos C: The tension-time index and the frequency/tidal volume ratio are the major pathophysiologic determinants of weaning failure and success. Am J Respir Crit Care Med. 1998, 158: 378-385.PubMed
34.
Vassilakopoulos T, Routsi C, Sotiropoulo C, Bitsakou C, Stanopoulos I, Roussos C, Zakynthinos S: The combination of the load/force balance and the frequency/tidal volume can predict weaning outcome. Intensive Care Med. 2006, 32: 684-691. 10.1007/s00134-006-0104-y.PubMed
35.
Lee KH, Hui KP, Chan TB, Tan WC, Lim TK: Rapid shallow breathing (frequencytidal volume ratio) did not predict extubation outcome. Chest. 1994, 105: 540-543. 10.1378/chest.105.2.540.PubMed
36.
Epstein SK: Evaluation of the rapid shallow breathing index in the clinical setting. Am J Respir Crit Care Med. 1995, 152: 545-549.PubMed
37.
Pierson DJ: Weaning from mechanical ventilation: why all the confusion?. Resp Care. 1995, 40: 228-233.
38.
Krieger BP, Isber J, Breitenbucher A, Throop G, Ershowsky P: Serial measurements of the rapid-shallow breathing index as a predictor of weaning outcome in elderly medical patients. Chest. 1997, 112: 1029-1034. 10.1378/chest.112.4.1029.PubMed
39.
Alvisi R, Volta CA, Righini ER, Capuzzo M, Ragazzi R, Verri M, Candini G, Gritti G, Milic-Emili J: Predictors of weaning outcome in chronic obstructive pulmonary disease patients. Eur Respir J. 2000, 15: 656-662. 10.1034/j.1399-3003.2000.15d06.x.PubMed
40.
Tanios M, Nevins M, Hendra K, Cardinal P, Allan J, Naumova E, Epstein S: A randomized, controlled trial of the role of weaning predictors in clinical decision making. Crit Care Med. 2006, 34: 2530-2535. 10.1097/01.CCM.0000236546.98861.25.PubMed
41.
Tobin MJ: Advances in mechanical ventilation. N Engl J Med. 2001, 344: 1986-1996. 10.1056/NEJM200106283442606.PubMed
42.
Kuhlen R, Hausmann S, Pappert D, Slama K, Rossaint R, Falke K: A new method for P0.1 measurement using standard respiratory equipment. Intensive Care Med. 1995, 21: 554-560. 10.1007/BF01700159.PubMed
43.
Capdevila XJ, Perrigault PF, Perey PJ, Roustan JP, d'Athis F: Occlusion pressure and its ratio to maximum inspiratory pressure are useful predictors for successful extubation following T-piece weaning trial. Chest. 1995, 108: 482-489. 10.1378/chest.108.2.482.PubMed
44.
Hess D, Kacmarek R: Weaning from mechanical ventilation. Essentials of Mechanical Ventilation. 2002, Columbus, OH: McGraw-Hill, 121-135. 2
45.
Jones DP, Byrne P, Morgan C, Fraser I, Hyland R: Positive end-expiratory pressure versus T-piece; extubation after mechanical ventilation. Chest. 1991, 100: 1655-1659. 10.1378/chest.100.6.1655.PubMed
46.
Wysocki M, Cracco C, Teixeira A, Mercat A, Diehl J-L, Lefort Y, Derenne J-P, Similowski T: Reduced breathing variability as a predictor of unsuccessful patient separation from mechanical ventilation. Crit Care Med. 2006, 34: 2076-2083. 10.1097/01.CCM.0000227175.83575.E9.PubMed
47.
Perren A, Domenighetti G, Mauri S, Genini F, Vizzardi N: Protocol-directed weaning from mechanical ventilation: clinical outcome in patients randomized for a 30-min or 120-min trial with pressure support ventilation. Intensive Care Med. 2002, 28: 1058-1063. 10.1007/s00134-002-1353-z.PubMed
48.
Vitacca M, Vianello A, Colombo D, Clini E, Porta R, Bianchi L, Arcaro G, Vitale G, Guffanti E, Lo Coco A, Ambrosino N: Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days. Am J Respir Crit Care Med. 2001, 164: 225-230.PubMed
49.
Banner MJ, Kirby RR, Blanch PB, Layon AJ: Decreasing imposed work of breathing apparatus to zero using pressure-support ventilation. Crit Care Med. 1993, 21: 1333-1338.PubMed
50.
Brochard L, Rua F, Lorino H, Lemaire F, Harf A: Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube. Anesthesiology. 1991, 75: 739-745. 10.1097/00000542-199111000-00004.PubMed
51.
Wright PE, Marini JJ, Bernard GR: In vitro versus in vivo comparison of endotracheal tube airflow resistance. Am Rev Respir Dis. 1989, 140: 10-16.PubMed
52.
Ezingeard E, Diconne e, Guyomarc'h S, Venet C, Page D, Gery P, Vermsch R, Bertrand M, Pingat J, Tardy B, Bertrand JC, Zeni F: Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing. Intensive Care Med. 2006, 32: 165-169. 10.1007/s00134-005-2852-5.PubMed
53.
Imsand C, Feihl F, Perret C, Fitting JW: Regulation of inspiratory neuromuscular output during synchronized intermittent mechanical ventilation. Anesthesiology. 1994, 80: 13-22. 10.1097/00000542-199401000-00006.PubMed
54.
Marini JJ, Rodriguez RM, Lamb V: The inspiratory workload of patient-initiated mechanical ventilation. Am Rev Respir Dis. 1986, 134: 902-909.PubMed
55.
Leung P, Jubran A, Tobin MJ: Comparison of assisted ventilator modes on triggering, patient effort, and dyspnea. Am J Respir Crit Care Med. 1997, 155: 1940-8.PubMed
56.
Kuhlen R, Max M, Dembinski R, Terbeck S, Jurgens E, Rossaint R: Breathing pattern and workload during automatic tube compensation, pressure support and T-piece trials in weaning patients. Eur J Anaesthesiol. 2003, 20: 10-6. 10.1017/S0265021503000024.PubMed
57.
Cohen J, Shapiro M, Grozovski E, Lev S, Fisher H, Singer P: Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure. Crit Care Med. 2006, 34: 682-686. 10.1097/01.CCM.0000201888.32663.6A.PubMed
58.
Georgopoulos D: Proprtional assist ventilation: an alternative approach to wean the patient. Eur J Anaesthesiol. 1998, 15: 756-760.PubMed
59.
Sinderby C, Beck J: Proportional assist ventilation and neurally adjusted ventilatory assist – better approaches to patient ventilator synchrony?. Clin Chest Med. 2008, 29: 329-342. 10.1016/j.ccm.2008.01.007.PubMed
60.
Del Rosario N, Sassoon CS, Chetty KG, Gruer SE, Mahutte CK: Breathing pattern during acute respiratory failure and recovery. Eur Respir J. 1997, 10: 2560-2565. 10.1183/09031936.97.10112560.PubMed
61.
Kirton OC, DeHaven CB, Morgan JP, Windsor J, Civetta JM: Elevated imposed work of breathing masquerading as ventilator weaning intolerance. Chest. 1995, 108: 1021-1025. 10.1378/chest.108.4.1021.PubMed
62.
Strauss C, Louis B, Isabey D, Lemaire F, Harf A, Brochard L: Contribution of the endotracheal tube and the upper airway to breathing workload. Am J Respir Crit Care Med. 1998, 157: 23-30.
63.
Manthous CA, Schmidt GA: Resistive pressure of a condenser humidifier in mechanically ventilated patients. Crit Care Med. 1994, 22: 1792-1795.PubMed
64.
Zanotti E, Rubini F, Iotti G, Braschi A, Palo A, Bruschi C, Fracchia C, Nava S: Elevated static compliance of the total respiratory system: early predictor of weaning unsuccess in several COPD patients mechanically ventilated. Intensive Care Med. 1995, 21: 399-405. 10.1007/BF01707408.PubMed
65.
Murata K, Kubota T: Impairment of chest wall mechanics and increased chest wall work of breathing cause postoperative respiratory failure in patients who have undergone radical esophagotomy. J Anesth. 2001, 15: 125-131. 10.1007/s005400170012.PubMed
66.
Tassaux D, Gainnier M, Battisti A, Jolliet P: Helium-oxygen decreases inspiratory effort and work of breathing during pressure support in intubated patients with chronic obstructive pulmonary disease. Intensive Care Med. 2005, 31: 1501-1507. 10.1007/s00134-005-2796-9.PubMed
67.
Ranieri VM, Mascia L, Petruzzelli V, Bruno F, Guiliani R: Inspiratory effort and measurement of dynamic intrinsic PEEP in COPD patients: effects of ventilator triggering systems. Intensive Care Med. 1995, 21: 896-903. 10.1007/BF01712330.PubMed
68.
Reddy VG: Auto-PEEP: how to detect and how to prevent. Middle East J Anesthesiol. 2005, 18: 293-312.PubMed
69.
Jubran A, Mathru M, Dries D, Tobin MJ: Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med. 1998, 158: 1763-1769.PubMed
70.
Marcellino R, Fernandes AP, Marum S, Ribeiro JP: The influence of cardiac diastole on weaning from mechanical ventilation. Rev Port Cardiol. 2002, 21: 849-857.
71.
Grasso S, Leone A, De Michele M, Anaclerio R, cafarelli A, Ancona G, Stripoli T, Bruno F, Pugliese P, Dambrosio M, Dalfino L, Di Serio F, Fiore T: Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease. Crit Care Med. 2007, 35: 96-105. 10.1097/01.CCM.0000250391.89780.64.PubMed
72.
Frazier SK, Brom H, Widener J, Pender L, Stone KS, Moser DK: Prevalence of myocardial ischemia during mechanical ventilation and weaning and its effects on weaning success. Heart Lung. 2006, 35: 363-373. 10.1016/j.hrtlng.2005.12.006.PubMed
73.
Srivastava S, Chatila W, Amoateng-Adjepong Y, Kanagasegar S, Jacob B, Zarich S, Manthous CA: Myocardial ischemia and weaning failure in patients with coronary artery disease: an update. Crit Care Med. 1999, 27: 2109-2112. 10.1097/00003246-199910000-00005.PubMed
74.
Vieira JM, Castro I, Curvello-Neto A, Demarzo S, Caruso P, Pastore L, Imanishe MH, Abdulakader RC, Deheinzelin D: Effect of acute kidney injury on weaning from mechanical ventilation in critically ill patients. Crit Care Med. 2007, 35: 184-191. 10.1097/01.CCM.0000249828.81705.65.PubMed
75.
Behnia M, Clay AS, Farber MO: Management of myxedematous respiratory failure: review of ventilation and weaning principles. Am J Med Sci. 2000, 320: 368-373. 10.1097/00000441-200012000-00003.PubMed
76.
Huang CJ, Lin HC: Association between adrenal insufficiency and ventilator weaning. Am J Respir Crit Care Med. 2006, 173: 276-280. 10.1164/rccm.200504-545OC.PubMed
77.
Frutos-Vivar F, Esteban A: Critical illness polyneuropathy: a new (or old?) reason for weaning failure. Crit Care Med. 2005, 33: 452-453. 10.1097/01.CCM.0000153525.37281.D4.PubMed
78.
Garnacho-Montero J, Amaya-Villar R, Garcia-Garmendia J, Madrazo-Osuna J, Ortiz-Leyba C: Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med. 2005, 33: 349-354. 10.1097/01.CCM.0000153521.41848.7E.PubMed
79.
Reid C: Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet. 2006, 19: 13-22. 10.1111/j.1365-277X.2006.00661.x.PubMed
80.
Pierson DJ: Nonrespiratory aspects of weaning from mechanical ventilation. Resp Care. 1995, 40: 263-271.
81.
Cook D, Meade M, Guyatt G, Butler R, Aldawood A, Epstein S: Trials of miscellaneous interventions to wean from mechanical ventilation. Chest. 2001, 120: 438S-444S. 10.1378/chest.120.6_suppl.438S.PubMed
82.
Martensson IE, Fridlund B: Factors influencing the patient during weaning from mechanical ventilation: a national survey. Intensive Crit Care Nurs. 2002, 18: 219-229. 10.1016/S0964339702000630.PubMed
83.
Thomas LA: Clinical management of stressors perceived by patients on mechanical ventilation. AACN Clin Issues. 2003, 14: 73-81.PubMed
84.
Nelson JE, Meier DE, Litke A, Natale DA, Siegel RE, Moeeison RS: The symptom burden of chronic critical illness. Crit Care Med. 2004, 32: 1527-1534. 10.1097/01.CCM.0000129485.08835.5A.PubMed
85.
Girard T, Kress J, Fuchs B, Thomason J, Schweickert W, Pun B, Taichman D, Dunn J, Pohlman A, Kinniry P, Jackson J, Canonico A, Light R, Shintani A, Thompson J, Gordon S, Hall J, Dittus R, Bernard G, Ely EW: Efficacy and safety of paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing Controlled trial): a randomized controlled trial. Lancet. 2008, 371: 126-134. 10.1016/S0140-6736(08)60105-1.PubMed
86.
Polese G, Massara A, Poggi R, Brandolese R, Brandi G, Rossi A: Flow-triggering reduces inspiratory effort during weaning from mechanical ventilation. Intensive Care Med. 1995, 21: 682-686. 10.1007/BF01711550.PubMed
87.
Racca F, Squadrone V, Ranieri VM: Patient-ventilator interaction during the triggering phase. Respir Care Clin N Am. 2005, 11: 225-245. 10.1016/j.rcc.2005.01.001.PubMed
88.
Shneerson JM: Are there new solutions to old problems with weaning. Br J Anaesth. 1997, 78: 238-240.PubMed
89.
Ely EW: The utility of weaning protocols to expedite liberation from mechanical ventilation. Respir Care Clin N Am. 2000, 6: 303-19. 10.1016/S1078-5337(05)70071-X.PubMed
90.
McLean SE, Jensen LA, Schroeder DG, Gibney NR, Skjodt NM: Improving adherence to a mechanical ventilation weaning protocol for critically ill adults: outcomes after implementation program. Am J Crit Care. 2006, 15: 299-309.PubMed
91.
Hendrix H, Kaiser ME, Yusen RD, Merk J: A randomized trial of automated versus conventional protocol-driven weaning from mechanical ventilation following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2006, 29: 957-963. 10.1016/j.ejcts.2006.01.036.PubMed
92.
Gutierrez CJ, Harrow J, Haines F: Using an evidence-based protocol to guide rehabilitation and weaning of ventilator-dependent cervical spinal cord injury patients. J Rehabil Res Dev. 2003, 40: 99-110.PubMed
93.
Ramachandran V, Jo Grap M, Sessler C: Protocol-directed weaning: a process of continuous performance improvement. Crit Care. 2005, 9: 138-140. 10.1186/cc3053.PubMedCentralPubMed
94.
Hill NS: Following protocol: weaning difficult-to-wean patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001, 164: 186-187.PubMed
95.
Marelich GP, Murin S, Battistella F, Inciardi J, Vierra T, Roby M: Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. Chest. 2000, 118: 459-467. 10.1378/chest.118.2.459.PubMed
96.
Dries DJ, McGonigal MD, Malian MS, Bor BJ, Sullivan C: Protocol-driven ventilator weaning reduces use of mechanical ventilation, rate of early reintubation, and ventilator-associated pneumonia. J Trauma. 2004, 56: 943-951.PubMed
97.
Iregui M, Ward S, Clinikscale D, Clayton D, Kollef MH: Use of handheld computer by respiratory care practitioners to improve the efficiency of weaning patients from mechanical ventilation. Crit Care Med. 2002, 30: 2038-2043. 10.1097/00003246-200209000-00014.PubMed
98.
Lellouche F, Mancebo J, Jolliet P, Roeseler J, Schortgen F, Dojat M, Cabello B, Bouadma L, Rodriguez P, Maggiore S, Reynaert M, Mersmann S, Brochard L: A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med. 2006, 174: 849-851. 10.1164/rccm.200511-1780OC.
99.
Petter AH, Chiolro RL, Cassina T, Chassot PG, Muller XM, Revelly JP: Automatic "respiratory/weaning" with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management. Anesth Analg. 2003, 97: 1743-1750. 10.1213/01.ANE.0000086728.36285.BE.PubMed
100.
Duane T, Riblet J, Golay D, Cole F, Weireter L, Britt L: Protocol-driven ventilator management in trauma intensive care unit population. Arch Surg. 2002, 137: 1223-1227. 10.1001/archsurg.137.11.1223.PubMed
101.
Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EH: Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996, 335: 1864-1869. 10.1056/NEJM199612193352502.PubMed
102.
Grap MJ, Strickland D, Tormey L, Keane K, Lubin S, Emerson J, Winfield S, Townes R, Sessler CN: Collaborative practice: development, implementation, and evaluation of weaning protocol for patients receiving mechanical ventilation. Am J Crit Care. 2003, 12: 454-460.PubMed
103.
Kollef MH, Shapiro SD, Silver P, St John RE, Prentice D, Sauer S, Ahrens TS, Shannon W, Baker-Clinkscale D: A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med. 1997, 25: 567-574. 10.1097/00003246-199704000-00004.PubMed
104.
Blackwood B, Wilson-Barnett J, Trinder J: Protocolized weaning from mechanical ventilation: ICU physicians' views. J Adv Nurs. 2004, 48: 26-34. 10.1111/j.1365-2648.2004.03165.x.PubMed
105.
Blackwood B, Wilson-Barnett J, Patterson CC, Trinder TJ, Lavery GG: An evaluation of protocolised weaning on the duration of mechanical ventilation. Anaesthesia. 2006, 61: 1079-1086. 10.1111/j.1365-2044.2006.04830.x.PubMed
106.
Tonnelier JM, Prat G, Le Gal G, Gut-Gobert C, Renault A, Boles JM, L'Her E: Impact of a nurses' protocol-directed weaning procedure on outcomes in patients undergoing mechanical ventilation for longer than 48 hours: a prospective cohort study with a matched historical control group. Crit Care. 2005, 9: R83-R89. 10.1186/cc3030.PubMedCentralPubMed
107.
Goodman S: Implementing a protocol for weaning patients off mechanical ventilation. Nurs Crit Care. 2006, 11: 23-32.PubMed
108.
Ferrer M, Esquinas A, Aranciba F, Thomas-Bauer T, Gonzalez G, Carrillo A, Rodriguez-Roisin R, Torres A: Noninvasive ventilation during persistent weaning failure. Am J Respir Crit Care Med. 2003, 168: 70-76. 10.1164/rccm.200209-1074OC.PubMed
109.
Nava S, Ambrossino N, Clini E, Prato M, Orlando G, Vitacca M, Brigada P, Fracchia C, Rubini F: Noninvasive mechanical ventilation in the weaning of patients with respiration failure due to chronic obstructive pulmonary disease: a randomized, controlled trial. Ann Intern Med. 1998, 128: 721-728.PubMed
110.
Burns KE, Adhikari NK, Meade MO: A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation. Can J Anaesth. 2006, 53: 305-315.PubMed
111.
Esteban A, Frutos-Vivar F, Ferguson N, Arabi Y, Apezteguia C, Gonzales M, Epstein S, Hill N, Nava S, Soares M-A, D'Empaire G, Alia I, Anzueto A: Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med. 2004, 350: 2452-2460. 10.1056/NEJMoa032736.PubMed
112.
Esteban A, Alia I, Gordo F, Fernandez R, Solsona J, Vallverdu I, Macias S, Allegue J, Blanco J, carriedo D, Leon M, de La Cal M, Taboada F, Gonzalea de Velasco J, Palazon E, Carrizosa F, Tomas R, Suarez J, Goldwasser R: Extubation outcome after spontaneous breathing trials with T-piece or pressure support ventilation: the Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1997, 156: 459-465.PubMed
113.
Esteban A, Alia I, Tobin M, Gil A, Gordo F, Vallverdu I, Blanch L, Bonet A, Vazquez A, de Pablo R, Torres A, de La Cal M, Macias S: Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation: Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1999, 159: 512-518.PubMed
114.
Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous C: Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest. 2001, 120: 1262-1270. 10.1378/chest.120.4.1262.PubMed
115.
Salam A, Tilluckdharry L, Amoateng-Adjepong Y, Manthous C: Neurologic status, cough, secretions and extubation outcomes. Intensive Care Med. 2004, 30: 1334-1339. 10.1007/s00134-004-2231-7.PubMed
116.
Francois B, Bellissant E, Gissot V, Desachy A, Sandrine N, Boulain T, Brenet O, Preux P-M, Vignon P: 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomized double-blind trial. Lancet. 2007, 369: 1083-1089. 10.1016/S0140-6736(07)60526-1.PubMed
117.
Pierson DJ: Tracheostomy and weaning. Respir Care. 2005, 50: 526-533.PubMed
118.
Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC: Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Crit Care. 2005, 9: R46-R52. 10.1186/cc3018.PubMedCentralPubMed
119.
Boynton JH, Hawkins K, Eastridge BJ, O'Keefe GE: Tracheostomy timing and the duration of weaning in patients with acute respiratory failure. Crit Care. 2004, 8: R261-R267. 10.1186/cc2885.PubMedCentralPubMed
120.
Diehl JL, El Atrous S, Trouchard D, Lemaire F, Brochard L: Changes in the work of breathing induced by tracheostomy in ventilator-dependent patients. Am J Respir Crit Care Med. 1999, 159: 383-388.PubMed
121.
Davis K, Campbell RS, Johannigman JA, Valente JF, Branson RD: Changes in respiratory mechanics after tracheostomy. Arch Surg. 1999, 134: 59-62. 10.1001/archsurg.134.1.59.PubMed
122.
Grinnan D, Truwit J: Clinical review: respiratory mechanics in spontaneous and assisted ventilation. Crit Care. 2005, 9: 472-484. 10.1186/cc3516.PubMedCentralPubMed
Metadata
Title
Clinical review: Liberation from mechanical ventilation
Authors
Mohamad F El-Khatib
Pierre Bou-Khalil
Publication date
01-08-2008
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2008
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc6959

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