Respiratory care clinics of North America
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Efforts to treat reversible disease processes that contribute to ventilator dependency in the intensive care unit (ICU) fail in up to 20% of patients, resulting in prolonged mechanical ventilation (PMV). Resolution of the insults that necessitated ICU admission and mechanical ventilation may be incomplete, and the economic pressure to transfer patients is ever increasing. ⋯ This article reviews data from a decade of weaning beyond the ICU, including outcomes of more than 2700 patients with PMV afforded continued attempts at liberation in long-term acute care facilities and other post-ICU weaning venues. Assessment and treatment, weaning strategies, and complications of patients with PMV are described.
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Although new ventilator modes have become available to facilitate weaning, there is little evidence that these have improved weaning outcomes. Knowledge based computer weaning systems have also been described, but these are in their infancy, and their role is unclear. Prospective, randomized clinical studies are required to examine whether such modalities are superior to existing approaches.