Skip to main content

Weaning, Tracheostomy, and Chest Physiotherapy

  • Chapter
  • First Online:
COVID-19 Critical and Intensive Care Medicine Essentials

Abstract

Weaning is gradual reduction of ventilation. A new systematic review suggests that noninvasive ventilation after early extubation helps in reducing the total days spent on invasive mechanical ventilation; also the patients spending less time on invasive ventilation had lower rates of ventilator-associated pneumonia [1, 2]. In some cases this process is rapid and uneventful; however, for some patients the process may be prolonged for days or weeks. Weaning is a term that is used in two separate ways. Firstly, it implies the termination of mechanical ventilation and secondly the removal of any artificial airway [1, 2].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EF. Effect on the duration of mechanical ventilation 165 of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335:1864–9.

    Article  CAS  Google Scholar 

  2. Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, Raymondos K, Nin N, Hurtado J, Tomicic V, González M, Elizalde J, Nightingale P, Abroug F, Pelosi P, Arabi Y, Moreno R, Jibaja M, D'Empaire G, Sandi F, Matamis D, Montañez AM, Anzueto A. Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med. 2008;177:170–7.

    Article  Google Scholar 

  3. Boles J-M, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T. Weaning from mechanical ventilation. Eur Respir J. 2007;29:1033–56.

    Article  Google Scholar 

  4. Peñuelas O, Frutos-Vivar F, Fernández C, Anzueto A, Epstein SK, Apezteguia C, González M, Nin N, Raymondos K, Tomicic V, Desmery P, Arabi Y, Pelosi P, Kuiper M, Jibaja M, Matamis D, Ferguson ND, Esteban A, For the Ventila Group. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. Am J Respir Crit Care Med. 2011;184:430–7.

    Article  Google Scholar 

  5. Funk G-C, Anders S, Breyer M-K, Burghuber OC, Edelmann G, Heindl W, Hinterholz G, Kohansal R, Schuster R, Schwarzmaier-D'Assie A, Valentin A, Hartl S. Incidence and outcome of weaning from mechanical ventilation according to new categories. Eur Respir J. 2010;35:88–94.

    Article  Google Scholar 

  6. Li Y, Li H, Zhang D. Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis. Crit Care. 2020;24:67.

    Article  Google Scholar 

  7. Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EF. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335:1864–9.

    Article  CAS  Google Scholar 

  8. Girard TD. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomised controlled trial. Lancet. 2008;371:126–34.

    Article  Google Scholar 

  9. Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342:1471–7.

    Article  CAS  Google Scholar 

  10. Matava CT, Yu J, Denning S. Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID-19. Can J Anaesth. 2020;67:902–4.

    Article  CAS  Google Scholar 

  11. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9.

    Article  CAS  Google Scholar 

  12. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052–9.

    Article  CAS  Google Scholar 

  13. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with Covid-19 using the ISARIC WHO clinical characterisation protocol: prospective observational cohort study. BMJ. 2020;369:m1985.

    Article  Google Scholar 

  14. Argenziano MG, Bruce SL, Slater CL, Tiao JR, Baldwin MR, Barr RG, et al. Characterization and clinical course of 1000 patients with Coronavirus disease 2019 in New York: retrospective case series. BMJ. 2020;369:m1996.

    Article  Google Scholar 

  15. Vargas M, Servillo G. Improving staff safety during tracheostomy in COVID-19 patients. Head Neck. 2020;42(6):1278–9.

    Article  Google Scholar 

  16. Vargas M, Russo G, Iacovazzo C, Servillo G. Modified percutaneous tracheostomy in COVID-19 critically ill patients. Head Neck. 2020;42(7):1363–6.

    Article  Google Scholar 

  17. McGrath B, Brenner M, Warrillow S, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet. 2020;8:717–25.

    CAS  Google Scholar 

  18. David A, Russel M, El-Sayed I, et al. Tracheostomy guidelines developed at a large academic medical center during the COVID-19 pandemic. Head Neck. 2020;42:1291–6.

    Article  Google Scholar 

  19. The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19 preliminary report. N Engl Med. 2020;384:693–704. https://doi.org/10.1056/NEJMoa2021436.

    Article  Google Scholar 

  20. Vargas M, Sutherasan Y, Antonelli M, et al. Tracheostomy procedures in the intensive care unit: an international survey. Crit Care. 2015;19(1):291.

    Article  Google Scholar 

  21. Bailey P, George T, Vick S, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35:139–45.

    Article  Google Scholar 

  22. Burtin C, Clerckx B, Robbeets C, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009;37(9):2499–505.

    Article  Google Scholar 

  23. World Confederation for Physical Therapy. Policy statement: description of physical therapy. http://www.wcpt.org/policy/ps-descriptionPT.

  24. Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med. 2013;41:1543–54.

    Article  Google Scholar 

  25. Sommers J, Engelbert RH, Dettling-Ihnenfeldt D, et al. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clin Rehabil. 2015;29:1051–63.

    Article  Google Scholar 

  26. Bourdin G, Barbier J, Burle JF, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55:400–7.

    PubMed  Google Scholar 

  27. Calvo-Ayala E, Khan BA, Farber MO, et al. Interventions to improve the physical function of ICU survivors: a systematic review. Chest. 2013;144:1469–80.

    Article  Google Scholar 

  28. Gerovasili V, Stefanidis K, Vitzilaios K, et al. Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study. Crit Care. 2009;13:R161.

    Article  Google Scholar 

  29. Hodgson CL, Tipping CJ. Physiotherapy management of intensive care unit-acquired weakness. J Physiother. 2017;63(1):4–10.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pascale, C., Servillo, G., Russo, G., Vargas, M. (2022). Weaning, Tracheostomy, and Chest Physiotherapy. In: Battaglini, D., Pelosi, P. (eds) COVID-19 Critical and Intensive Care Medicine Essentials. Springer, Cham. https://doi.org/10.1007/978-3-030-94992-1_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-94992-1_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-94991-4

  • Online ISBN: 978-3-030-94992-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics