Discontinuing mechanical ventilatory support.

Published

Journal Article (Review)

The ventilator discontinuation process is a critical component of ICU care. Ongoing ventilator dependency is caused by both disease factors (eg, respiratory, cardiac, metabolic, and neuromuscular) and clinician management factors (eg, failing to recognize discontinuation potential and inappropriate ventilator settings/management). A multispecialty evidence-based task force has recommended a series of guidelines that begins with a daily ventilator weaning screen focusing on disease stability/recovery, gas exchange, hemodynamics, and respiratory drive that should be done on every patient receiving mechanical ventilatory support. In those passing this screen, a spontaneous breathing trial (SBT) should be performed. The decision to remove the artificial airway in those patients successfully passing an SBT requires further assessment of the patient's ability to protect the airway. Managing the patient who fails the SBT is one of the biggest challenges facing ICU clinicians. In general, stable, comfortable modes of assisted/supported ventilatory support should be provided between the daily weaning screen/SBT. New evidence suggests that early tracheostomy placement may facilitate the ventilator withdrawal process in those patients requiring prolonged ventilatory support.

Full Text

Duke Authors

Cited Authors

  • MacIntyre, N

Published Date

  • September 2007

Published In

Volume / Issue

  • 132 / 3

Start / End Page

  • 1049 - 1056

PubMed ID

  • 17873200

Pubmed Central ID

  • 17873200

International Standard Serial Number (ISSN)

  • 0012-3692

Digital Object Identifier (DOI)

  • 10.1378/chest.06-2862

Language

  • eng

Conference Location

  • United States