It is a pleasure and honor for me to give the 26th Annual Donald F Egan Scientific Lecture at the American Association for Respiratory Care. Much of my research career has focused on weaning from mechanical ventilation, and a major stimulus for my interest in this subject was an outstanding review article published in RESPIRATORY CARE by its current editor, Dave Pierson, in the early 1980s.1 In...

The microprocessor has greatly changed ventilator technology. When I started residency, intubation and mechanical ventilation involved assuming complete control of a patient’s breathing. Since then, advances in technology have fed the boundless human desire for improvement and spurred the ambition of engineers to overcome the challenges involved in creating better and better ventilators. The ve...

Half the patients in an intensive care unit receive mechanical ventilation and almost half of intubated time is devoted to weaning. Accordingly, weaning constitutes an enormous workload for intensive care staff (1). Two deliberate steps are involved in weaning. First, patient readiness is tested with physiological measurements, usually called weaning predictors (2, 3). Second, the patient is ev...

Weaning from mechanical ventilation involves the reduction or withdrawal of ventilatory support in proportion to the patient's ability to sustain spontaneous ventilation. Protocolized weaning has been shown to reduce weaning duration; however, its weakness lies in the reliance on human intervention. Automated weaning is theoretically superior to manual weaning because of its ability to rapidly ...

In preparing for influenza pandemics, public health agencies stockpile critical medical resources. Determining appropriate quantities and locations for such resources can be challenging, given the considerable uncertainty in the timing and severity of future pandemics. We introduce a method for optimizing stockpiles of mechanical ventilators, which are critical for treating hospitalized influen...

interest the recent randomized controlled trial comparing sustained low-effi ciency dialysis using a single-pass batch dialysis system (SLED-BD) with continuous veno-venous hemofi ltration (CVVH) [1]. I congratulate the authors on their undertaking but have serious concerns regarding the majority of their analysis. After each table at the end of the paper, the authors report the use of a ‘one-t...

BACKGROUND Previous studies have demonstrated that protocol-directed weaning is better than physician-directed weaning in terms of shorter duration of mechanical ventilation in general critically ill patients. In this prospective, randomized controlled trial, the authors compared duration of mechanical ventilation between protocol based nurse-directed weaning and physician-directed weaning in p...

During mechanical ventilation in small animals a discrepancy between tidal volume applied through a piston ventilator and the measured volume displacement of the thorax occurs. Such differences, which can be as large as (10-30 %) depend on the mechanical properties of the lungs and thorax, as well as the volume and resistance of the tubing system. In this study we evaluate an adaptive controlle...

Ideally, the inspired (tidal) volume (V(T)) provided by a volume-controlled ventilation device should not change when the pressure imposed on the ventilator varies. A bench study evaluation of V(T) versus pressure was performed on 10 commercially available devices. The difference between the desired V(T) and the observed V(T) reached 100 mL for some devices when inspiratory resistance was at it...

BACKGROUND New home ventilators are able to provide clinicians data of interest through built-in software. Monitoring of tidal volume (VT) is a key point in the assessment of the efficacy of home mechanical ventilation. OBJECTIVE To assess the reliability of the VT provided by 5 ventilators in a bench test. METHODS Five commercial ventilators from 4 different manufacturers were tested in pr...