Tag: weaning
Validation of RSBI Displayed by the Ventilator vs. Standard Technique in Patients with Readiness for Weaning
The ventilator significantly overestimates the RSBI value compared to the standard technique by Wright spirometer. The average RSBI vent value among 5 time points (0, 15, 30, 45, and 60 s) was found to best correlate with... read more
NIV After Early Extubation Reduces Total Days Spent on i-MV
Patients recovering from an episode of hypoxemic acute respiratory failure (hARF) may benefit from a weaning strategy based on early extubation followed by immediate noninvasive ventilation (NIV) application. Compared... read more
Replacement of Fentanyl Infusion by Enteral Methadone Decreases the Weaning Time From Mechanical Ventilation
The introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients resulted in a decrease in the weaning time from mechanical ventilation (MV). A double-blind randomized... read more
Ventilator Weaning and Discontinuation Practices for Critically Ill Patients
In this observational study of invasive mechanical ventilation discontinuation in 142 ICUs in Canada, India, the UK, Europe, Australia/New Zealand, and the US from 2013 to 2016, weaning practices varied internationally. Among... read more
Trauma ICU Rounds – The rEVOLUTION of ECMO
What are the indications for ECMO beyond ARDS and refractory cardiogenic shock? In which patients should we consider eCPR and is this the new standard of care for patients sustaining out-of-hospital cardiac arrest? Finally,... read more
Weaning the patient: between protocols and physiology
Ventilator weaning forms an integral part in critical care medicine and strategies to shorten duration are rapidly evolving alongside our knowledge of the relevant physiological processes. The purpose of the current review... read more
Natriuretic Peptide–driven Fluid Management during Ventilator Weaning
Our results suggest that a BNP-driven fluid management strategy decreases the duration of weaning without increasing adverse events, especially in patients with left ventricular systolic dysfunction. In a randomized controlled... read more
Efficacy and Safety of a Paired Sedation and Ventilator Weaning
The purpose of this study is to determine the impact of a new RN/RRT (Registered Nurse/Registered Respiratory Therapist) directed 2-step protocol to wean patients off of a ventilator. This protocol involves daily attempts... read more
LV Overloading Identified by Critical Care Echocardiography is Key in Weaning‑induced Pulmonary Edema
Spontaneous breathing trial (SBT) failure due to WIPO appears related to overloaded LV, including the worsening or development of mitral regurgitation, associated with excessive accumulated fluid balance. SBT-induced central... read more
Mechanical Ventilation: Physiology and Practice
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... read more
How I Approach Weaning from Venoarterial ECMO
Weaning from VA-ECMO remains a challenging but critically important step in device management. The key is to balance minimizing complications associated with device support with the potential for hemodynamic deterioration... read more
Impact of Levosimendan on Weaning from Peripheral VA-ECMO in ICU
This study suggests that levosimendan might be associated with a beneficial effect on venoarterial extracorporeal membrane oxygenation (VA-ECMO) weaning in ICU patients. The difference in mortality among propensity-matched... read more
Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure
Among patients requiring mechanical ventilation in whom a spontaneous breathing trial had failed, early extubation to noninvasive ventilation did not shorten time to liberation from any ventilation. Among 364 randomized... read more
Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Ventilation
This complex randomized, controlled trial failed to demonstrate that early extubation to non-invasive ventilation reduced the total time of mechanical ventilation. I will continue to extubate early and will use non-invasive... read more
Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients
Liberating patients from ongoing invasive mechanical ventilation is typically a 3-step process. First, clinicians must recognize that patients may no longer require mechanical ventilation, when the reasons for intubation... read more
Myocardial Ischemia During Ventilator Weaning
This observational study showed the pulmonary edema (WiPO) occurred in a significant number of critically ill patients who failed a first spontaneous breathing trial (SBT), while cardiac ischemia (WiCI) was less frequent.... read more
Automated vs. Non-automated Weaning for Reducing Mechanical Ventilation Duration for Critically Ill
Automated systems may result in clinically meaningful reduced durations of weaning, ventilation and ICU stay. Overall, these systems appear to be safe and can be considered a reasonable approach in the management of ventilator... read more
