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Critical Care
Published in: Critical Care 5/2009

01-10-2009 | Commentary

Routine use of weaning predictors: not so fast

Author: Scott K Epstein

Published in: Critical Care | Issue 5/2009

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Abstract

Weaning from mechanical ventilation remains a major challenge for critical care physicians. Because subjective criteria are inaccurate, objective measurements consisting of clinical criteria and physiologic tests (weaning predictors) have been used to facilitate decision-making. An integrated weaning index calculated as the product of static compliance and arterial oxygen saturation divided by the frequency-tidal volume ratio appears to be more accurate than other currently available predictors. Despite the accuracy of this new test, a beneficial effect on outcome is yet to be proven.
Literature
1.
Nemer SN, Barbas CSV, Caldeira JB, Cárias TC, Santos RG, Almeida LC, Azeredo LM, Noé RA, Guimaräes BS, Souza PC: A new integrative weaning index of discontinuation from mechanical ventilation. Crit Care 2009, 13: R152. 10.1186/cc8051PubMedCentralCrossRefPubMed
2.
Meade M, Guyatt G, Cook D, Griffith L, Sinuff T, Kergl C, Mancebo J, Esteban A, Epstein S: Predicting success in weaning from mechanical ventilation. Chest 2001, 120: 400S-424S. 10.1378/chest.120.6_suppl.400SCrossRefPubMed
3.
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.CrossRefPubMed
4.
Milic-Emili J: Is weaning an art or a science? Am Rev Respir Dis 1986, 134: 1107-1108.PubMed
5.
Jabour ER, Rabil DM, Truwit JD, Rochester DF: Evaluation of a new weaning index based on ventilatory endurance and the efficiency of gas exchange. Am Rev Respir Dis 1991, 144: 531-537.CrossRefPubMed
6.
MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinhorn 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 of Critical Care Medicine. Chest 2001, 120: 375S-395S. 10.1378/chest.120.6_suppl.375SCrossRefPubMed
7.
Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T: Weaning from mechanical ventilation. Eur Respir J 2007, 29: 1033-1056. 10.1183/09031936.00010206CrossRefPubMed
8.
Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW: Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 2008, 371: 126-134. 10.1016/S0140-6736(08)60105-1CrossRefPubMed
9.
Ely EW, Bennett PA, Bowton DL, Murphy SM, Florance AM, Haponik EF: Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning. Am J Respir Crit Care Med 1999, 159: 439-446.CrossRefPubMed
10.
Laghi F, Cattapan SE, Jubran A, Parthasarathy S, Warshawsky P, Choi YS, Tobin MJ: Is weaning failure caused by low-frequency fatigue of the diaphragm? Am J Respir Crit Care Med 2003, 167: 120-127. 10.1164/rccm.200210-1246OCCrossRefPubMed
11.
Funk GC, Anders S, Breyer MK, Burghuber OC, Edelmann G, Heindl W, Hinterholzer G, Kohansal R, Schuster R, Schwarzmaier-D'Assie A, Valentin A, Hartl S: Incidence and outcome of weaning from mechanical ventilation according to new categories. Eur Respir J 2009. 10.1183/09031936.00056909
12.
Tanios MA, Nevins ML, Hendra KP, Cardinal P, Allan JE, Naumova EN, Epstein SK: 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.0000236546.98861.25CrossRefPubMed
Metadata
Title
Routine use of weaning predictors: not so fast
Author
Scott K Epstein
Publication date
01-10-2009
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2009
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc8121

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