Weaning from ventilatory support

被引:82
作者
Epstein, Scott K. [1 ]
机构
[1] Tufts Univ, Sch Med, Off Educ Affairs, Boston, MA 02111 USA
关键词
extubation; mechanical ventilation; reintubation; respiratory failure; weaning; OBSTRUCTIVE PULMONARY-DISEASE; SPONTANEOUS BREATHING TRIAL; PROLONGED MECHANICAL VENTILATION; POSITIVE-PRESSURE VENTILATION; IMPLEMENTED SEDATION PROTOCOL; AUTOMATIC TUBE COMPENSATION; END-EXPIRATORY PRESSURE; TERM-CARE HOSPITALS; RESPIRATORY-FAILURE; NONINVASIVE VENTILATION;
D O I
10.1097/MCC.0b013e3283220e07
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose of review In intubated patients, mechanical ventilation offers essential ventilatory support, while the respiratory system recovers from acute respiratory failure. Yet, invasive mechanical ventilation is associated with risks and complications that prolong the duration of mechanical ventilation and increase the risk for death. Therefore, safely weaning the patient from the ventilator as soon as possible is paramount. Recent randomized trials have addressed a number of key areas of interest. Recent findings Determining readiness for spontaneous breathing, the first step in weaning, is best achieved using liberal oxygenation criteria; does not require routine use of weaning predictors; and can be conducted, in certain patient populations, using protocols driven by respiratory therapists or ICU nurses. Spontaneous breathing trials can be conducted on low levels of pressure support, continuous positive airway pressure, or T-piece. Weaning failure often results from an imbalance between respiratory load and capacity. There is increasing appreciation that cardiac dysfunction can limit weaning. Recent randomized trials suggest that noninvasive ventilation (in patients with chronic obstructive pulmonary disease) and computer-driven approaches show promise as weaning strategies. New techniques have been employed to identify patients at increased risk for extubation failure. Noninvasive ventilation, when used in high-risk patients, can decrease extubation failure. Summary Weaning from mechanical ventilation continues to be an area of considerable importance. Recent randomized controlled trials provide high-level evidence for the best approaches to weaning and extubation.
引用
收藏
页码:36 / 43
页数:8
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共 103 条
  • [91] Outcomes in post-ICU mechanical ventilation - A therapist-implemented weaning protocol
    Scheinhorn, DJ
    Chao, DC
    Stearn-Hassenpflug, M
    Wallace, WA
    [J]. CHEST, 2001, 119 (01) : 236 - 242
  • [92] A randomized, controlled trial of the role of weaning predictors in clinical decision making
    Tanios, Maged A.
    Nevins, Michael L.
    Hendra, Katherine P.
    Cardinal, Pierre
    Allan, Jill E.
    Naumova, Elena N.
    Epstein, Scott K.
    [J]. CRITICAL CARE MEDICINE, 2006, 34 (10) : 2530 - 2535
  • [93] Serial measurements of f/VT can predict extubation failure in patients with f/VT ≤ 105?
    Teixeira, Cassiano
    Zimermann Teixeira, Paulo Jose
    Hoher, Jorge Amilton
    de Leon, Patricia Pickersgill
    Monteiro Brodt, Sergio Fernando
    Moreira, Jose da Siva
    [J]. JOURNAL OF CRITICAL CARE, 2008, 23 (04) : 572 - 576
  • [94] Variable performance of weaning-predictor tests: role of Bayes' theorem and spectrum and test-referral bias
    Tobin, Martin J.
    Jubran, Amal
    [J]. INTENSIVE CARE MEDICINE, 2006, 32 (12) : 2002 - 2012
  • [95] Fluid balance and weaning outcomes
    Upadya, A
    Tilluckdharry, L
    Muralidharan, V
    Amoateng-Adjepong, Y
    Manthous, CA
    [J]. INTENSIVE CARE MEDICINE, 2005, 31 (12) : 1643 - 1647
  • [96] Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation
    Vallverdú, I
    Calaf, N
    Subirana, M
    Net, A
    Benito, S
    Mancebo, J
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 158 (06) : 1855 - 1862
  • [97] Respiratory failure in chronic obstructive pulmonary disease after extubation: value of expiratory flow limitation and airway occlusion pressure after 0.1 second (P0.1)
    Vargas, Frederic
    Boyer, Alexandre
    Bui, Hoang Nam
    Salmi, Louis Rachid
    Guenard, Herve
    Gruson, Didier
    Hilbert, Gilles
    [J]. JOURNAL OF CRITICAL CARE, 2008, 23 (04) : 577 - 584
  • [98] The combination of the load/force balance and the frequency/tidal volume can predict weaning outcome
    Vassilakopoulos, T
    Routsi, C
    Sotiropoulou, C
    Bitsakou, C
    Stanopoulos, I
    Roussos, C
    Zakynthinos, S
    [J]. INTENSIVE CARE MEDICINE, 2006, 32 (05) : 684 - 691
  • [99] The tension-time index and the frequency/tidal volume ratio are the major pathophysiologic determinants of weaning failure and success
    Vassilakopoulos, T
    Zakynthinos, S
    Roussos, C
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 158 (02) : 378 - 385
  • [100] Ventilator-induced diaphragmatic dysfunction
    Vassilakopoulos, T
    Petrof, BJ
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2004, 169 (03) : 336 - 341