Tag: weaning

Upvote Story 5
A score derived from ventilator settings may help clinicians predict the timing of ventilator liberation in patients requiring prolonged mechanical ventilation. Of 372 patients, 72% were liberated from mechanical ventilation. The ventilator independence score measured on the day after tracheostomy placement had an area under the receiver operating characteristic curve value of 0.71 (95% CI, 0.65–0.76) for differentiating patients who were liberated within the next... Read More | Comment
Upvote Story 7
Mechanical ventilation is an essential life-sustaining therapy for many critically-ill patients. As technology has evolved, clinicians have been presented with an increasing number of ventilator options as well as an ever-expanding and confusing list of terms, abbreviations, and acronyms. Unfortunately, this has made it extremely difficult for clinicians at all levels of training to truly understand mechanical ventilation and to optimally manage patients with respiratory... Read More | Comment
Upvote Story 11
This book establishes the indications for the use of NIV in the context of weaning from invasive mechanical ventilation. It provides a comprehensive overview of key topics relevant for correct practical application, including NIV and weaning principles, important aspects of patient care before and after weaning, and pediatric and neonatology weaning. Finally, the book summarizes international guidelines and new perspectives of NIV during weaning. With... Read More | Comment
Upvote Story 5
As evidence-based guidance to aid clinicians with mechanical ventilation mode selection is scant, we sought to characterize the epidemiology thereof within a university healthcare system and hypothesized that nonconforming approaches could be readily identified. We conducted an exploratory retrospective observational database study of routinely recorded mechanical ventilation parameters between January 1, 2010 and December 31, 2016 from 12 intensive care units. Read More | Comment
Upvote Story 20
Current research is focusing on preventing extubation failure, especially in the most challenging cases. The use of weaning protocols – written or computerized – attempts to early identify patients who are able to breathe spontaneously and to hasten extubation, resulting in better outcomes. Nevertheless, individualized care is needed in the most vulnerable patients, trying to prompt weaning without exposing patients to unnecessary risks. The results... Read More | Comment
Upvote Story 8
Respiratory muscle dysfunction, being a common cause of weaning failure, is strongly associated with prolonged mechanical ventilation (MV) and prolonged stay in intensive care units. Strategies to improve weaning outcomes – i.e., spontaneous breathing trials, noninvasive MV and early mobilisation – can help patients to interrupt MV, according to a review paper published in the journal Respiratory Medicine. Identifying strategies to reduce the duration of... Read More | Comment
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Rehabilitative exercise for critically ill patients may have many benefits; however, it is unknown what intensive care unit (ICU) clinicians perceive to be important rationale for the implementation of rehabilitative exercise in critical care settings. Any shortcoming in implementation of rehabilitation exercise is unlikely attributable to a lack of perceived importance by nursing, medical or physiotherapy clinicians who are the most likely clinicians to influence... Read More | Comment
Upvote Story 11
In this pilot RCT we demonstrated that a nurse-led weaning protocol from tracheostomy was feasible and safe. A larger RCT is justified to assess efficacy. We enrolled 65 patients, 27 were in the protocol group and 38 in the control group. Of 27 patients in the protocol group, 1 (3.7%) died in the ICU, 24 (88.9%) were successfully weaned from tracheostomy, and 2 (7.4%) were... Read More | Comment
Upvote Story 9
This prospective observational multicentre study (ARREVE) was done in 43 French ICUs to compare terminal weaning and immediate extubation, as chosen by the ICU team. Terminal weaning was a gradual decrease in the amount of ventilatory assistance and immediate extubation was extubation without any previous decrease in ventilatory assistance. We enrolled 212 (85.5%) relatives of 248 patients with terminal weaning and 190 relatives (90.5%) of... Read More | Comment
Upvote Story 6
Physical rehabilitation can benefit critically ill patients during ICU admission, but routine clinical practice remains inconsistent nor examined in prolonged mechanical ventilation patients transferred to a specialist ventilator weaning unit (VWU). Behavioral mapping is a sampling approach that allows detailed reporting of physical activity profiles. The objective of this study was to characterize the physical activity profile of critically ill patients in a UK ICU... Read More | Comment
Upvote Story 8
About 20% to 30% of patients are difficult to wean from invasive mechanical ventilation. The pathophysiology of difficult weaning is complex. Accordingly, determining the reason for difficult weaning and subsequently developing a treatment strategy require a dedicated clinician with in-depth knowledge of the pathophysiology of weaning failure. This review presents a structural framework ('ABCDE') for the assessment and treatment of difficult-to-wean patients. Earlier recognition of... Read More | Comment