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Evidence-based ventilator weaning and discontinuation.

Publication ,  Journal Article
MacIntyre, NR
Published in: Respir Care
July 2004

Ventilator management of a patient who is recovering from acute respiratory failure must balance competing objectives. Discontinuing mechanical ventilation and removing the artificial airway as soon as possible reduces the risk of ventilator-induced lung injury, nosocomial pneumonia, airway trauma from the endotracheal tube, and unnecessary sedation, but premature ventilator-discontinuation or extubation can cause ventilatory muscle fatigue, gas exchange failure, and loss of airway protection. In 1999 the McMaster University Outcomes Research Unit conducted a comprehensive evidence-based review of the literature on ventilator-discontinuation. Using that literature review, the American College of Chest Physicians, the Society of Critical Care Medicine, and the American Association for Respiratory Care created evidence-based guidelines, which include the following principles: 1. Frequent assessment is required to determine whether ventilatory support and the artificial airway are still needed. 2. Patients who continue to require support should be continually re-evaluated to assure that all factors contributing to ventilator dependence are addressed. 3. With patients who continue to require support, the support strategy should maximize patient comfort and provide muscle unloading. 4. Patients who require prolonged ventilatory support beyond the intensive care unit should go to specialized facilities that can provide more gradual support reduction strategies. 5. Ventilator-discontinuation and weaning protocols can be effectively carried out by nonphysician clinicians.

Duke Scholars

Published In

Respir Care

ISSN

0020-1324

Publication Date

July 2004

Volume

49

Issue

7

Start / End Page

830 / 836

Location

United States

Related Subject Headings

  • Ventilator Weaning
  • United States
  • Respiratory System
  • Respiration, Artificial
  • Practice Guidelines as Topic
  • Nursing Homes
  • Long-Term Care
  • Humans
  • Evidence-Based Medicine
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
MacIntyre, N. R. (2004). Evidence-based ventilator weaning and discontinuation. Respir Care, 49(7), 830–836.
MacIntyre, Neil R. “Evidence-based ventilator weaning and discontinuation.Respir Care 49, no. 7 (July 2004): 830–36.
MacIntyre NR. Evidence-based ventilator weaning and discontinuation. Respir Care. 2004 Jul;49(7):830–6.
MacIntyre, Neil R. “Evidence-based ventilator weaning and discontinuation.Respir Care, vol. 49, no. 7, July 2004, pp. 830–36.
MacIntyre NR. Evidence-based ventilator weaning and discontinuation. Respir Care. 2004 Jul;49(7):830–836.

Published In

Respir Care

ISSN

0020-1324

Publication Date

July 2004

Volume

49

Issue

7

Start / End Page

830 / 836

Location

United States

Related Subject Headings

  • Ventilator Weaning
  • United States
  • Respiratory System
  • Respiration, Artificial
  • Practice Guidelines as Topic
  • Nursing Homes
  • Long-Term Care
  • Humans
  • Evidence-Based Medicine
  • 1103 Clinical Sciences