Weaning from prolonged mechanical ventilation

Clinics in Chest Medicine
M L Nevins, S K Epstein

Abstract

The development of weaning failure and need for PMV is multifactorial in origin, involving disorders of pulmonary mechanics and complications associated with critical illness. The underlying disease process is clearly important when discussing mechanisms of ventilator dependence; interventions therefore must be tailored to individual patients. Unfortunately, the main conclusion that can be drawn from the sum of the studies investigating patients on PMV to date is that an evidence-based approach to weaning is not possible and more research needs to be done. New studies need to incorporate severity-of-illness scores and an assessment of principal and comorbid conditions to allow for comparison of the findings from different centers. The best approach to a patient requiring PMV after exclusion of easily treatable conditions is not known. The literature regarding both acute and chronic cases suggests that a systematic approach to weaning involving the participation of multiple caregivers, including nurses, physicians, and respiratory, physical, and speech therapists facilitates liberation from MV. Although a gradual decrement in ventilator support would seem prudent, Scheinhorn et al have begun to identify a subpopulation of patien...Continue Reading

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Citations

Dec 13, 2005·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Robert G SvitekWilliam J Federspiel
Apr 29, 2008·Clinics in Chest Medicine·Christopher King, Lisa K Moores
Jun 18, 2009·Nursing in Critical Care·Cheryl Crocker
Dec 3, 2016·Journal of Intensive Care Medicine·Paul A ClarkChristopher J Lettieri
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Jan 12, 2021·The Open Respiratory Medicine Journal·Salim SuraniAlamgir Khan

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