Comparison of Pressure Support Ventilation (PSV) and Intermittent Mandatory Ventilation (IMV) during Weaning in Patients with Acute Respiratory Failure

Esen, Figen; Denkel, T.; Telci, Lütfi; Kesecioğlu, Jozef; Tütüncü, Ahmet; Akpir, K.; Lachmann, B.

doi:10.1007/978-1-4615-3428-0_41

Cited by 40 publications

(12 citation statements)

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“…3 Over the past decade, clinical investigations have focused on strategies to limit the duration of ventilation, for example, early identification of patients who are likely to be weaned, [4][5][6] tests of readiness to resume spontaneous breathing trials (SBTs), [7][8][9] and strategies to reduce support in patients who fail a SBT. [10][11][12] Several modes and techniques have been used to liberate critically ill adults from invasive mechanical ventilation. The optimal strategy to wean patients from invasive ventilation remains unclear.…”

Section: Résumémentioning

confidence: 99%

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Burns

Lellouche²,

Slutsky

et al. 2009

Can J Anesth/J Can Anesth

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Purpose To determine the stated practices of clinicians in weaning critically ill adults from invasive ventilation. Methods We conducted a cross-sectional, self-administered postal survey of Critical Care physicians and respiratory therapists (RTs) in leadership roles at Canadian teaching hospitals. We identified respondents using electronic mail and telephone correspondence. We used rigorous survey methodology to develop, test, and administer the questionnaire.Results One hundred ten of 162 (67.9%) clinicians returned the survey with 99 respondents (55 physicians and 44 RTs) completing it either in-part or in-full. Approximately 95% of respondents acknowledged ever performing spontaneous breathing trials (SBTs) in clinical practice. Of these, 95.6% and 32% of respondents reported conducting daily and twice-daily screening to identify SBT candidates, at least sometimes. The three most common techniques to conduct SBTs included; pressure support (PS) with positive end-expiratory pressure (70.8%), continuous positive airway pressure (35.7%), and use of a T-piece (25.0%). PS ventilation was the weaning strategy used most frequently before SBTs. Most respondents (57.1%) considered continuous infusion of sedative-hypnotics to be a relative contraindication to tracheal extubation. However, concurrent administration of low dose vasopressors, inotropes, and analgesic boluses, or continuous analgesic infusions were considered acceptable amongst 60.8%, 73.2%, 78.4% -009-9124-8 and 58.8% of respondents, respectively. We did not observe regional variation in whether clinicians ever perform SBTs, the ventilatory modes used prior to an SBT nor in the use of PS and SBTs during the weaning process. Conclusions Pressure support and SBTs are common features of weaning in Canadian teaching hospitals. Compared to the published literature, our survey suggests that weaning practices have evolved over time and that practice variation may be greater on an international level compared to a national level.123 Can J Anesth/J Can Anesth (2009) 56:567-576 DOI 10.1007/s12630 RésuméObjectif De´terminer les pratiques de´clare´es des cliniciens concernant le sevrage des patients adultes gravement malades de la ventilation invasive. Méthode Nous avons re´alise´un sondage transversal, auto-administre´et envoye´par courrier aupre`s des me´decins des soins critiques et des inhalothe´rapeutes occupant des positions de leadership dans les hôpitaux d'enseignement canadiens. Nous avons identifie´les re´pondants a`l'aide de correspondance par courrier e´lectronique et par te´le´phone. Nous avons utilise´une me´thodologie de sondage rigoureuse afin d'e´laborer, de tester et d'administrer le questionnaire. Résultats Sur un total de 162 cliniciens, 110 (67,9%) ont renvoye´le questionnaire; 99 re´pondants (55 me´decins et 44 inhalothe´rapeutes) ont comple´te´le questionnaire en entier ou en partie. Environ 95 % des re´pondants ont reconnu qu'ils re´alisaient des tests de ventilation spontane´e (TVS) dans leur pratique clinique. Parmi ceux-ci, 9...

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Section: Résumémentioning

confidence: 99%

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Burns

Lellouche²,

Slutsky

et al. 2009

Can J Anesth/J Can Anesth

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“…The third component was a stepwise reduction in ventilatory support. The evidence is inconclusive on which stepwise reduction method is best (Esen et al. 1992, Brochard et al.…”

Section: Evaluation Of Nurse‐led Weaning Using the Mrc Frameworkmentioning

confidence: 99%

“…The third component was a stepwise reduction in ventilatory support. The evidence is inconclusive on which stepwise reduction method is best (Esen et al 1992, Brochard et al 1994, Esteban et al 1995; therefore all methods may be considered suitable as long as there is a consistent plan (Butler et al 1999). The study involved a change in practice, and therefore theories of change management and behavioural change were reviewed, in particular, relevant UK research studies evaluating the implementation of evidencebased practice (Eve et al 1997, Donald 1998, Miller et al 1998, Dunning et al 1999, Redfern et al 2000 and two USA studies evaluating the implementation of weaning protocols , Ely et al 1999.…”

Section: Preclinical Phasementioning

confidence: 99%

Methodological issues in evaluating complex healthcare interventions

Blackwood

2006

Journal of Advanced Nursing

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The framework was a useful tool and can be easily applied in developing and evaluating complex nursing interventions. Three key challenges emerge from this experience: (i) relevant research evidence should be used systematically in developing the components of the intervention, (ii) the definition and measurement of complex intervention outcomes needs to be improved and (iii) appropriate research designs must be used when evaluating complex interventions.

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“…More than two decades of research support the use of specific strategies to limit the duration of invasive ventilation including the (i) use of multidisciplinary screening protocols to identify candidates for a spontaneous breathing trial (SBT) [9][10][11], (ii) conduct of SBTs [12][13][14] in patients who meet screening criteria, and (iii) use of specific modes and techniques [reductions in Pressure Support (PS) and once daily SBTs [PS ± positive end expiratory pressure (PEEP) or T-piece] [15][16][17] to discontinue support in patients who fail an initial SBT.…”

Section: Introductionmentioning

confidence: 99%

Frequency of Screening and SBT Technique Trial

Kea¹,

Rizvi²,

Dodek³

et al. 2016

J Clin Trials

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Rationale: Research supports the use of screening protocols to identify patients who are candidates for weaning from mechanical ventilation, and the use of spontaneous breathing trials (SBTs) to predict ability to breathe spontaneously. However, once daily screening is poorly aligned with 24-hour continuous care in the intensive care unit (ICU) environment and the most effective SBT technique is not known. The optimal strategy to liberate our sickest patients from ventilators remains to be determined. Objectives:To assess our ability to recruit critically ill adults and adhere to the screening and SBT protocols. Methods:We propose a pilot, factorial design, randomized trial comparing once-daily versus at least twice daily screening and pressure support (PS) ± positive end-expiratory pressure (PEEP) (inspiratory ± expiratory support) or T-piece (no support) as the SBT technique in critically ill adults who are invasively ventilated for at least 24 hours in 11 North American ICUs. Respiratory Therapists (RTs) will screen all enrolled patients between 06:00 and 08:00 hours daily to identify SBT candidates. Patients in the at least twice daily screening arms will also be screened between 13:00 and 15:00 hours; additional screening will be permitted at clinician's discretion. Once a screening assessment is passed, an SBT will be conducted with the assigned technique. Outcomes:The study will be considered feasible if at least 1 to 2 patients per ICU per month are recruited and if the screening and SBT protocols are adhered to >80% of the time.Relevance: The availability of RTs in ICUs presents an important opportunity to screen patients more frequently, conduct more frequent SBTs, and reduce the duration of invasive ventilation and ICU stay.

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Comparison of Pressure Support Ventilation (PSV) and Intermittent Mandatory Ventilation (IMV) during Weaning in Patients with Acute Respiratory Failure

Cited by 40 publications

References 7 publications

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Weaning critically ill adults from invasive mechanical ventilation: a national survey

Methodological issues in evaluating complex healthcare interventions

Frequency of Screening and SBT Technique Trial

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