Facilitation of early spontaneous breathing activity is the most important measure to shorten weaning and avoid ventilator-induced lung injury and diaphragmatic injury in mechanically ventilated patients. However, the optimal degree of spontaneous muscle activity and ventilator support remains to be determined. Furthermore, effectiveness in relation to the pathophysiology of respiratory failure...

Ventilator management of a patient who is recovering from acute respiratory failure must balance competing objectives. Discontinuing mechanical ventilation and removing the artificial airway as soon as possible reduces the risk of ventilator-induced lung injury, nosocomial pneumonia, airway trauma from the endotracheal tube, and unnecessary sedation, but premature ventilator-discontinuation or ...

D iscontinuation of ventilation is estimated to take up to 40% of the total duration of ventilatory support, and around 3–6% of patients admitted to the intensive care unit (ICU) require a prolonged course of mechanical ventilation (MV). Patients being liberated from ventilatory support therefore occupy a significantnumber of ICUbeds andhave a major impact on healthcare resources. There have be...

A patient failed to wean from mechanical ventilation. Her problem was unique in that she had a depressed central drive to breathe manifested by hypopnea when removed from the ventilator. After excluding the known problems that impair successful weaning, we empirically administered three separate infusions of doxapram, a respiratory stimulant. These infusions produced a dramatic improvement in s...

PURPOSE To determine if the ultimate ability of a long-term ventilated patient to wean can be predicted at the time of his or her admission to a long-term ventilator unit. DESIGN Two-phased prospective study. SETTING Long-term ventilator facility, university-affiliated. SUBJECTS Adults ventilated for an average of 3 weeks, who did not have sepsis and who did not have chest tubes or progre...

Tracheotomy is commonly performed in ventilator-dependent patients. Disadvantages to the procedure are perioperative complications, long-term airway injury, and the cost of the procedure. Benefits ascribed to tracheotomy vs prolonged translaryngeal intubation include improved patient comfort, more effective airway suctioning, decreased airway resistance, enhanced patient mobility, increased pot...

BACKGROUND In the context that special weaning units have been advocated as effective alternatives to the ICU for weaning selected patients, we initiated a Respiratory Special Care Unit (ReSCU) at the Cleveland Clinic Hospital in August 1993. The goals of the ReSCU were the following: (1) to wean ventilator-dependent patients when possible; and (2) when weaning was not possible, to optimize pat...

BACKGROUND Patient-ventilator asynchrony is a major cause of difficult weaning from mechanical ventilation. Neurally adjusted ventilatory assist (NAVA) is reported useful to improve the synchrony in patients with sustained low lung compliance. However, the role of NAVA has not been fully investigated. CASE PRESENTATION The patient was a 63-year-old Japanese man with acute respiratory distress...

BACKGROUND Subjects who do not pass ventilator weaning parameters but whose ambient air oxyhemoglobin saturation can be normalized by mechanical insufflation-exsufflation (MIE) can be extubated to continuous noninvasive ventilatory support (CNVS) with MIE used to maintain extubation. Our aim was to study MIE-associated changes in breathing tolerance, pulse oximetry, and vital capacity (VC) for ...