Weaning from Mechanical Ventilation
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Mechanical ventilation plays a crucial role in the management of critically ill patients. Prolonged ventilatory support is associated with an increase in clinical complications, ICU length of stay and mortality. Liberation from the mechanical ventilator, commonly referred to as weaning, is the process of withdrawing ventilatory support after the underlying pathophysiologic process that resulted in respiratory failure improves.
Due to complications arising from prolonged mechanical ventilation, evidence based strategies that prevent the need for intubation or minimize the duration of mechanical ventilation are recommended. A daily approach to evaluating the patient’s readiness for liberation from mechanical ventilation has been demonstrated to reduce the time to successful extubation and overall ICU length of stay. A successful spontaneous breathing trial in a patient with demonstrated ability to protect the airway should be followed by immediate extubation.
Varying levels of evidence support the use of adjunct measures to predict, minimize and treat patients who develop post-extubation stridor. Ultrasonographic imaging of the diaphragm to predict readiness for liberation from mechanical ventilation and automated weaning protocols may reduce the time to successful extubation. Insufficient evidence exists to demonstrate superiority of low-level pressure support over T-tube in weaning, and the optimal time to perform tracheostomies in patients requiring prolonged weaning remains controversial.
KeywordsWeaning Liberation Spontaneous breathing trial Mechanical ventilation
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