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.
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Over the last decade, investigators have increasingly focused on the process of translaryngeal extubation. Depending on the patient population studied, the frequency of extubation failure varies from 2% to 20%. ⋯ Commonly used weaning predictors are much less accurate in foretelling extubation outcome. Rapid reinstitution of either invasive or noninvasive ventilatory support has the potential to improve the outcome of extubation failure.
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Outcomes of critically ill patients are affected by the severity of the acute illnesses and by complications that may result from treatments. This article reviews the major complications associated with mechanical ventilation. Special emphasis is placed on recent advances in the understanding of ventilator-induced lung injury and strategies to avoid this life-threatening complication. In this update, the incidence, diagnosis, prevention, and management of complications associated with mechanical ventilation are discussed for each major organ system.
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Respir Care Clin N Am · Jun 2000
ReviewThe utility of weaning protocols to expedite liberation from mechanical ventilation.
Over the past decade, a number of studies have examined methods of hastening liberation of patients from mechanical ventilation. This article outlines weaning protocols that have been proven superior to weaning performed by board-certified intensivists. The author also presents techniques to faciliate the implementation of weaning protocols based on the published experience of one hospital.