Streamlining weaning: protocols and weaning units

Of principles and protocols and weaning.

Half the patients in an intensive care unit receive mechanical ventilation and almost half of intubated time is devoted to weaning. Accordingly, weaning constitutes an enormous workload for intensive care staff (1). Two deliberate steps are involved in weaning. First, patient readiness is tested with physiological measurements, usually called weaning predictors (2, 3). Second, the patient is ev...

Ventilator Weaning Protocols: Influencing Outcomes and Promoting Success

Tracheostomy and weaning.

No hypothesis relating to respiratory care in the intensive care unit has proved more difficult to study in an objective fashion than the commonly held belief that tracheostomy hastens weaning from ventilatory support. Tracheostomy might facilitate weaning by reducing dead space and decreasing airway resistance, by improving secretion clearance, by reducing the need for sedation, and by decreas...

Weaning from mechanical ventilation

Practice guidelines on weaning should be based on the results of several well-designed randomized studies performed over the last decade. One of those studies demonstrated that immediate extubation after successful trials of spontaneous breathing expedites weaning and reduces the duration of mechanical ventilation as compared with a more gradual discontinuation of ventilatory support. Two other...

Weaning From Mechanical Ventilation

• To review the frequency of weaning failure • To discuss the logic of weaning, ie, questions to ask when approaching the ventilated patient • To assess available predictors of weaning success and failure • To describe the techniques of weaning and the evidence supporting their use • To understand special considerations in weaning, eg, auto-positive end-expiratory pressure, imposed work of brea...