Liberating Patients from Mechanical Ventilation: What Have We Learned About Protocolizing Care?

  • J. W. W. Thomason
  • E. W. Ely
Conference paper
Part of the Update in Intensive Care Medicine book series (UICMSOFT)


Intensive Care Unit Mechanical Ventilation Respir Crit Pressure Support Ventilation Spontaneous Breathing Trial 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hess DR (2002) Liberation from mechanical ventilation: Weaning the patient or weaning old-fashioned ideas? Crit Care Med 30:2154–2155PubMedGoogle Scholar
  2. 2.
    MacIntyre NR, Cook DJ, Ely EW, et al (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support a collective task force facilitated by the american college of chest physicians; the american association for respiratory care; and the american college of critical care medicine. Chest 120(suppl):375S–395SPubMedGoogle Scholar
  3. 3.
    Krieger BP (2002) Top ten list in mechanical ventilation. Chest 122:1797–1800PubMedGoogle Scholar
  4. 4.
    Tobin MJ (2001) Advances in mechanical ventilation. N Engl J Med 344:1986–1996CrossRefPubMedGoogle Scholar
  5. 5.
    Esteban A, Alia I, Ibanez J, Benito S, Tobin MJ (1994) The Spanish Lung Failure Collaborative Group, Modes of mechanical ventilation and weaning. Chest 106:1188–1193PubMedGoogle Scholar
  6. 6.
    Esteban A, Anzueto A, Frutos F, et al (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation a 28-day international study. JAMA 287:345–355CrossRefPubMedGoogle Scholar
  7. 7.
    Stroetz RW, Hubmayr RD (1995) Tidal volume maintenance during weaning with pressure support. Am J Respir Crit Care Med 152:1034–1040PubMedGoogle Scholar
  8. 8.
    Listello D, Sessler C (1994) Unplanned extubation: clinical predictors for reintubation. Chest 105:1496–1503PubMedGoogle Scholar
  9. 9.
    Tindol GA, Jr., DiBenedetto RJ, Kosciuk L (1994) Unplanned extubations. Chest 105:1804–1807PubMedGoogle Scholar
  10. 10.
    Boulain T, and the Association des Reanimateurs du Centre-Ouest (1998) Unplanned extubations in the adult intensive care unit: a prospective multicenter study. Am J Respir Crit Care Med 157:1131–1137PubMedGoogle Scholar
  11. 11.
    Betbese AJ, Perez M, Rialp G, et al (1998) A prospective study of unplanned endotracheal extubation in intensive care unit patients. Crit Care Med 26:1180–1186PubMedGoogle Scholar
  12. 12.
    Khamiees M, Raju P, Amoateng-Adjepong Y, Manthous CA (2001) Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 120:1262–1270CrossRefPubMedGoogle Scholar
  13. 13.
    Ely EW, Bennett PA, Bowton DL, et al (1999) Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning. Am J Respir Crit Care Med 159:439–446PubMedGoogle Scholar
  14. 14.
    Laghi F, Cattapan SE, Jubran A, et al (2003) Is weaning failure caused by low-frequency fatigue of the diaphragm? Am J Respir Crit Care Med 167:120–127CrossRefPubMedGoogle Scholar
  15. 15.
    Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 324:1445–1450PubMedCrossRefGoogle Scholar
  16. 16.
    Hoo GW, Park L (2002) Variations in the measurement of weaning parameters: a survey of respiratory therapists. Chest 121:1947–1955Google Scholar
  17. 17.
    Sahn SA, Lakshminarayan S (1973) Bedside criteria for discontinuation of mechanical ventilation. Chest 63:1002–1005PubMedGoogle Scholar
  18. 18.
    Brochard L, Rauss A, Benito S, et al (1994) Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150:896–903PubMedGoogle Scholar
  19. 19.
    Esteban A, Frutos F, Tobin MJ, et al (1995) A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 332:345–350CrossRefPubMedGoogle Scholar
  20. 20.
    Ely EW, Baker AM, Dunagan DP, et al (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335:1864–1869CrossRefPubMedGoogle Scholar
  21. 21.
    Wood KE, Flaten AL, Reedy JS, Coursin DB (1999) Use of a daily screen and weaning protocol for mechanically ventilated patients in a multidisciplinary tertiary critical care unit. Crit Care Med 27:A94–A94Google Scholar
  22. 22.
    Kollef MH, Shapiro SD, Silver P, et al (1997) A randomized, controlled trial of protocol-directed versus physician-directed weaning from Mechanical Ventilation. Crit Care Med 25:567–574PubMedGoogle Scholar
  23. 23.
    Strickland JH Jr, Hasson JH (1993) Acomputer-controlled ventilator weaning system: a clinical trial. Chest 103:1220–1226PubMedGoogle Scholar
  24. 24.
    Marelich GP, Murin S, Battistella F, et al (2000) Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: Effect on weaning time and incidence of ventilator-associated pneumonia. Chest 118:459–467CrossRefPubMedGoogle Scholar
  25. 25.
    Foster GH, Conway WA, Pamulkov N, et al (1984) Early extubation after coronary artery bypass: brief report. Crit Care Med 12:994–996PubMedGoogle Scholar
  26. 26.
    Tong DA (1991) Weaning patients from mechanical ventilation. A knowledge-based system approach. Comput Methods Programs Biomed 35:267–278CrossRefPubMedGoogle Scholar
  27. 27.
    Rotello LC, Warren J, Jastremski MS, et al (1992) A nurse-directed protocol using pulse oximetry to wean mechanically ventilated patients from toxic oxygen concentrations. Chest 102:1833–1835PubMedGoogle Scholar
  28. 28.
    Wood G, MacLeod B, Moffatt S (1995) Weaning from mechanical ventilation: physician-directed vs a respiratory-therapist-directed protocol. Respir Care 40:219–224PubMedGoogle Scholar
  29. 29.
    Saura P, Blanch L, Mestre J, et al (1996) Clinical consequences of the implementation of a weaning protocol. Intensive Care Med 22:1052–1056PubMedGoogle Scholar
  30. 30.
    Djunaedi H, Cardinal P, Greffe-Laliberte G, et al (1987) Does a ventilatory management protocol improve the care of ventilated patients? Respir Care 42:604–610Google Scholar
  31. 31.
    Burn SM, Marshall M, Burns JE, et al (1998) Design, testing, and results of an outcomes-managed approach to patients requiring prolonged mechanical ventilation. Am J Crit Care 7:45–57Google Scholar
  32. 32.
    Horst HM, Mouro D, Hall-Jenssens RA, et al (1998) Decrease in ventilation time with a standardized weaning process. Arch Surg 133:483–488PubMedGoogle Scholar
  33. 33.
    Kollef MH, Horst HM, Prang L, et al (1998) Reducing the duration of mechanical ventilation: three examples of change in the intensive care unit. New Horiz 6:52–60PubMedGoogle Scholar
  34. 34.
    Cohen IL, Booth FV (1994) Cost containment and mechanical ventilation in the United States. New Horiz 2:283–290PubMedGoogle Scholar
  35. 35.
    Cohen IL (1994) Weaning from mechanical ventilation —the team approach and beyond. Intensive Care Med 20:317–318CrossRefPubMedGoogle Scholar
  36. 36.
    Smyrnios NA, Connolly A, Wilson MM, et al (2002) Effects of a multifaceted, multidisciplinary, hospital-wide quality improvement program on weaning from mechanical ventilation. Crit Care Med 30:1224–1230PubMedGoogle Scholar
  37. 37.
    Esteban A, Alia I, Tobin M, et al (1999) Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Am J Respir Crit Care Med 159:512–518PubMedGoogle Scholar
  38. 38.
    Perrren A, Domenighetti G, Mauri S, Genini F, Vizzardi N (2002) Protocol-driven weaning from mechanical ventilation: clinical outcome in patients randomized for a 30-min or 120-min trial with pressure support ventilation. Intensive Care Med 28:1058–1063Google Scholar
  39. 39.
    Esteban A, Alia I, Gordo F, et al (1997) The Spanish Lung Failure Collaborative Group. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med 156:459–465PubMedGoogle Scholar
  40. 40.
    Esteban A, Anzueto A, Alia I, et al (2000) How is mechanical ventilation employed in the intensive care unit. Am J Respir Crit Care Med 161:1450–1458PubMedGoogle Scholar
  41. 41.
    Vitacca M, Vianello A, Colombo D, et al (2001) Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days. Am J Respir Crit Care Med 164:225–230PubMedGoogle Scholar
  42. 42.
    Iregui M, Ward S, Clinikscale D, Clayton D, Kollef MH (2002) Use of a handheld computer by respiratory care practitioners to improve the efficiency of weaning patients from mechanical ventilation. Crit Care Med 30:2038–2043PubMedGoogle Scholar
  43. 43.
    Croft B (2002) Ventilator weaning protocols. Journal for Respiratory Care Practitioners. Aug/Sept, pp:26–30Google Scholar
  44. 44.
    Ely EW (2000) The utility of weaning protocols to expedite liberation from mechanical ventilation. Respir Care Clin N Am 6:303–319PubMedGoogle Scholar
  45. 45.
    Brattebo G, Hofoss D, Flaatten H, Muri AK, Gjerde S, Plsek P (2002) Effect of a scoring system and protocol for sedation on duration of patient’s need for ventilator support in a surgical intensive care unit. Br Med J 324:1386–1389Google Scholar
  46. 46.
    Main DS, Cohen SJ, DiClemente CC (1995) Measuring physician readiness to change cancer screening: preliminary results. Am J Prev Med 11:54–58PubMedGoogle Scholar
  47. 47.
    Fridkin SK, Pear SM, Williamson TH, et al (1996) The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 17:150–158PubMedCrossRefGoogle Scholar
  48. 48.
    Archibald LK, Manning ML, Bell LM, et al (1997) Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis 16:1045–1048Google Scholar
  49. 49.
    Thorens JB, Kaelin RM, Jolliet P, et al (1995) Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. Crit Care Med 23:1807–1815PubMedGoogle Scholar
  50. 50.
    Damen J, van Diejen D, Bakker J, van Zanten ARH (2003) Legal implications of clinical practice guidelines. Intensive Care Med 29:3–7PubMedGoogle Scholar
  51. 51.
    Jacobi J, Fraser GL, Coursin DB, et al (2002) Clinical practice guidelines for the susstained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–140PubMedGoogle Scholar
  52. 52.
    Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477CrossRefPubMedGoogle Scholar
  53. 53.
    Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G (1998) The use of continuous iv sedation is associated with prolongation of mechanical ventilation. Chest 114:541–548PubMedGoogle Scholar
  54. 54.
    Randolph AG, Wypij D, Venkataraman ST, et al (2002) Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children a randomized controlled trial. JAMA 288:2561–2568CrossRefPubMedGoogle Scholar
  55. 55.
    O’meade MO, Ely EW (2002) Protocols to improve the care of critically ill pediatric and adult patients. JAMA 288:2601–2603Google Scholar
  56. 56.
    Mascia MF, Koch M, Medicis JJ (2000) Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care. Crit Care Med 28:2300–2306PubMedGoogle Scholar
  57. 57.
    Brook AD, Ahrens TS, Schaiff R, et al (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27: 2609–2615PubMedGoogle Scholar
  58. 58.
    Ely EW, Margolin R, Francis J, May L, et al (1999) Delirium in the ICU: measurement and outcomes. Am J Respir Crit Care Med 161:A506 (abst)Google Scholar
  59. 59.
    Ely EW, Inouye SK, Bernard GR, et al (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAMICU). JAMA 286:2703–2710CrossRefPubMedGoogle Scholar
  60. 60.
    Thomason JWW, Truman B, Ely EW, et al (2003) The impact of delirium in the ICU on outcomes of mechanical ventilation. Am J Respir Crit Care Med 167:A970 (abst)Google Scholar
  61. 61.
    Ely EW, Stephens R, Jackson JC, et al (2003) Current opinions regarding delirium in the ICU: A survey of 915 healthcare professionals. Crit Care Med (in press)Google Scholar
  62. 62.
    Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Mancebo J (1998) Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial of patients weaning from mechanical ventilation. Am J Respir Crit Care Med 158:1855–1862PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Authors and Affiliations

  • J. W. W. Thomason
  • E. W. Ely

There are no affiliations available

Personalised recommendations