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Intensive Care for Emergency Surgeons pp 57–71Cite as

Principles of Weaning from Ventilatory Support: When and Why to Wean and When to Consider a Tracheostomy

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Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

Abstract

Weaning and tracheostomy are two high-priority topics in intensive because extubation failure and prolonged mechanical ventilation both increase mortality. Still there are no clinical guidelines or gold standards to suggest the best practice for both, and many controversies are evinced by literature. It is crucial to screen systematically each day patient’s readiness to discontinuation because mortality risk increases every day after the first separation attempt; thus categorizing patients according to length of weaning process is fundamental to understand the prognosis. Key points of weaning are those reducing time to successful extubation. The suspicion that extubation may be possible should start a daily assessment or weaning and discontinuation readiness. When in doubt screening tests like f/Vt ratio could be performed before spontaneous breathing trial (SBT). Tracheostomy has become a common intervention in critically ill patients especially after the introduction of percutaneous techniques. Techniques and timing are issues of significant and often inconclusive debate in literature. Mortality of tracheostomized ventilated patients at 1 year is more than 50%. Therefore the current strategy should be to individualize the approach to tracheostomy taking into consideration the patient underlying comorbidities, reason for mechanical ventilation, potential complications, and life expectancy.

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Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, M. Bufalini Hospital, Cesena, Italy

    G. Pizzilli & V. Agnoletti

  2. Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy

    E. Brogi

  3. Department of Emergency and Trauma Surgery, M. Bufalini Hospital, Cesena, Italy

    L. Ansaloni & F. Coccolini

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  1. G. Pizzilli
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  2. E. Brogi
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  3. V. Agnoletti
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  4. L. Ansaloni
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  5. F. Coccolini
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Correspondence to G. Pizzilli .

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Editors and Affiliations

  1. Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy

    Edoardo Picetti

  2. Division of Trauma, Department of Surgery, University of Campinas, Campinas, São Paulo, Brazil

    Bruno M. Pereira

  3. Department of Surgery, McGill University, Montreal, QC, Canada

    Tarek Razek

  4. Department of Surgery/ Division of Trauma, Burns, Critical and Acute Care, Weill Cornell Medicine/ New York-Presbyterian Hospital, New York, USA

    Mayur Narayan

  5. Department of Surgery, Tel Aviv University, Tel Aviv, Israel

    Jeffry L. Kashuk

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Pizzilli, G., Brogi, E., Agnoletti, V., Ansaloni, L., Coccolini, F. (2019). Principles of Weaning from Ventilatory Support: When and Why to Wean and When to Consider a Tracheostomy. In: Picetti, E., Pereira, B., Razek, T., Narayan, M., Kashuk, J. (eds) Intensive Care for Emergency Surgeons. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-11830-3_4

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