PMID: 15222913Jun 30, 2004Paper

Evidence-based ventilator weaning and discontinuation

Respiratory Care
Neil R MacIntyre

Abstract

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 extubation can cause ventilatory muscle fatigue, gas exchange failure, and loss of airway protection. In 1999 the McMaster University Outcomes Research Unit conducted a comprehensive evidence-based review of the literature on ventilator-discontinuation. Using that literature review, the American College of Chest Physicians, the Society of Critical Care Medicine, and the American Association for Respiratory Care created evidence-based guidelines, which include the following principles: 1. Frequent assessment is required to determine whether ventilatory support and the artificial airway are still needed. 2. Patients who continue to require support should be continually re-evaluated to assure that all factors contributing to ventilator dependence are addressed. 3. With patients who continue to require support, the support strategy should max...Continue Reading

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