RATIONALE Adrenal insufficiency is a common disorder in critically ill patients with mechanical ventilation and is usually associated with higher mortality and poor clinical outcome. OBJECTIVES To determine whether stress dose corticosteroid supplementation can improve ventilator weaning and clinical outcome in patients with adrenal insufficiency. METHODS A prospective, randomized, placebo ...

BACKGROUND Weaning is the process during which mechanical ventilation is withdrawn and the work of breathing is transferred from the ventilator back to the patient. Prolonged weaning is associated with development of ventilator-related complications and longer stays in the Intensive Care Unit (ICU). Computerized or Automated Weaning is a novel weaning strategy that continuously measures and ada...

Ventilator management strategies can affect the risk for ventilator-associated pneumonia in 3 ways: the development of ventilator-induced lung injury; the need for potentially harmful tradeoffs in providing lung-protective ventilatory strategies; and the prolongation of the duration of mechanical ventilation from iatrogenic factors. Strategies to reduce ventilator-induced lung injury include a ...

Mechanical ventilation is a life-saving supportive therapy, but it can also cause lung injury, diaphragmatic dysfunction, and lung infection. Ventilator liberation should be attempted as soon as clinically indicated, to minimize morbidity and mortality. The most effective method of liberation follows a systematic approach that includes a daily assessment of weaning readiness, in conjunction wi...

The term "weaning" is used to describe the gradual process of decreasing ventilator support. It is estimated that 40% of the duration of mechanical ventilation is dedicated to the process of weaning. Spontaneous breathing trial (SBT) assesses the patient's ability to breathe while receiving minimal or no ventilator support. The collective task force in 2001 stated that the process of SBT and we...

Weaning techniques include spontaneous breathing trials (SBTs), pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV). SBTs can be conducted using one of several approaches, including T-piece breathing, low-level continuous positive airway pressure, low-level PSV, or setting the ventilator to flow-triggering with no pressure applied to the airway. The SB...

Background Maximal inspiratory pressure (MIP) is used to assess respiratory muscle strength of patients with myasthenia gravis (MG) requiring ventilatory support. Electrical activity of the diaphragm (E-di) has been used to guide weaning. Case presentation The MIP and tidal volume/ΔE-di (the patient-to-ventilator breath contribution) were monitored in a 12-year-old girl with MG requiring vent...

HYPOTHESIS The use of weaning and sedation protocols affects the intensive care unit (ICU) course of a trauma population. DESIGN Nonrandomized before-after trial. SETTING A level I trauma center. PATIENTS Three hundred twenty-eight consecutive trauma patients receiving mechanical ventilation treated in the ICU between October 1, 1997, and November 1, 1999. INTERVENTION Sedation and wean...

BACKGROUND Therapist-implemented protocols have been used to extubate or wean patients in the ICU setting. Barlow Respiratory Hospital (BRH) functions as a center for weaning patients from prolonged mechanical ventilation (PMV) in the post-ICU setting of a long-term acute-care (LTAC) facility. A therapist-implemented patient-specific (TIPS) weaning protocol was developed at BRH to standardize w...