BACKGROUND There is increasing evidence that weaning protocols improve outcome from mechanical ventilation, but it is unclear how best to implement such protocols in large intensive care units. We evaluated a checklist of simple bedside criteria to determine whether it could be used reliably to predict successful discontinuation of mechanical ventilation. METHODS We carried out a prospective ...

This paper reviews management strategies for patients undergoing prolonged mechanical ventilation (PMV). Topics covered include how to identify and correct barriers to weaning, the systematic approach to weaning trials, when to cease weaning trials and proceed with life-long support, managing the tracheostomy tube during PMV, and, finally, how to select a suitable mechanical ventilator for PMV.

∙ Patient surveillance technology can improve adherence to and optimization of ventilator protocols, shorten the time on the ventilator, and reduce the likelihood of acute lung injury. ∙ Patient surveillance technology can aid clinicians in preventing or reducing the incidence of adverse ventilator associated events, including ventilator-associated pneumonia, and ultimately, help improve patien...

INTRODUCTION Physiological determinants of weaning success and failure are usually studied in ventilator-supported patients, comparing those who failed a trial of spontaneous breathing with those who tolerated such a trial and were successfully extubated. A major limitation of these studies was that the two groups may be not comparable concerning the severity of the underlying disease and the p...

Copyright © 2012 Massachusetts Medical Society. In the United States, almost 800,000 patients who are hospitalized each year require mechanical ventilation.1 This estimate excludes neonates, and there is little doubt that mechanical ventilation will be increasingly used as the number of patients 65 years of age or older continues to increase.2,3 The majority of patients who receive mechanical v...

Objective: To review the evidence as to whether early extubation with immediate application of non-invasive ventilation reduces mortality and ventilator-associated pneumonia and improves other outcomes in criticallyill adults receiving invasive ventilation. Data sources: Medline, Embase, CENTRAL, searched up to April, 2008. This search was supplemented by hand-searching of conference proceeding...

Weaning comprises 40 percent of the duration of mechanical ventilation. Protocols to reduce weaning time and to identify candidates at the earliest possible moment have been introduced to reduce complications and costs. Increased demand for mechanical ventilation, an increase in the number of patients requiring prolonged ventilation, and resource/staffing issues have created an environment whe...

BACKGROUND Weaning protocols expedite extubation in mechanically ventilated patients, yet the literature investigating the application in tracheostomized patients remains scarce. The primary objective of this parallel randomized controlled pilot trial (RCT) was to assess the feasibility and safety of a nurse-led weaning protocol (protocol) compared to weaning based on physician's clinical judgm...