Most patients who require mechanical ventilation for longer than 24 hours, and who improve the condition leading to the indication of ventilatory support, can be weaned after passing a first spontaneous breathing test. The challenge is to improve the weaning of patients who fail that first test. We have methods that can be referred to as traditional, such as the T-tube, pressure support or sync...

BACKGROUND For weaning patients from prolonged mechanical ventilation, we previously designed a respiratory-therapist-implemented weaning protocol that decreased median weaning time from 29 days to 17 days. An acceleration step at the start of the protocol allowed patients with a rapid shallow breathing index (RSBI) of < or = 80 to advance directly to spontaneous breathing trials (SBTs). METH...

Results 423 attendants completed the survey (response rate: 66%) of which 342 ICU nurses were included for further analysis. These are employed in general (73%) or university hospitals (27%) and are working in mixed (66%), surgical (18%) or medical (13%) ICUs. Short working agents are most frequently chosen for analgo-sedation. A majority of respondents administer sedatives in continuous infusi...

Failure to transition patient from controlled mechanical ventilation to spontaneous breathing trials (SBTs) in a timely fashion is associated with significant morbidity and mortality in the intensive care unit. In addition, weaning failures are common in patients with limited cardiac reserves. Recent advances in cardiac echocardiography and laboratory measurement of serum biomarkers to assess h...

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BACKGROUND The CO2 response test measures the hypercapnic drive response (which is defined as the ratio of the change in airway-occlusion pressure 0.1 s after the start of inspiratory flow [ΔP(0.1)] to the change in P(aCO2) [ΔP(aCO2)]), and the hypercapnic ventilatory response (which is defined as the ratio of the change in minute volume to ΔP(aCO2)). OBJECTIVE In mechanically ventilated pati...

Effects of Endotracheal Tubes in Spontaneously Breathing Patients Respiratory Workload Imposed by the Endotracheal Tube In healthy persons, respiration occurs with little effort. Respiratory work is required, however, to overcome the natural forces that oppose inhalation, such as the elasticity and resistance of the respiratory system, which is termed respiratory load. The ability to overcome t...

INTRODUCTION Indexes predicting weaning outcome are frequently inaccurate. We developed a new integrative weaning index aimed at improving the accuracy of the traditional indexes. METHODS Three hundred and thirty-one patients mechanically-ventilated for more than 24 hours were evaluated. Initially, the threshold values of each index that best discriminate between a successful and an unsuccess...

We saw a patient who presented with carbon dioxide narcosis and acute respiratory failure due to an exacerbation of chronic obstructive pulmonary disease. We intubated and 12 hours later he had recovered consciousness and could cooperate with noninvasive ventilation, at which point we extubated and used a helmet to provide noninvasive positive-pressure ventilation in assist/control mode, and th...

T he timing of tracheal extubation after open heart surgery may accelerate recovery without increasing mortality. However, the manner of weaning from controlled mechanical ventilation (CMV) varies widely in different centers. Since 1972 an alternative means of ventilatory “support” advocated is that of intermittent mandatory ventilation ( IMV), in which an inadequate minute volume produced by t...