Effect on the Duration of Mechanical Ventilation of Identifying Patients Capable of Breathing Spontaneously

Ely, E. Wesley; Baker, Albert; Dunagan, Donnie P.; Burke, Henry L.; Smith, Allen C.; Kelly, Patrick T.; Johnson, Margaret M.; Browder, Rick W.; Bowton, David L.; Haponik, Edward F.

doi:10.1056/nejm199612193352502

Cited by 1,227 publications

(743 citation statements)

References 29 publications

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“…Decrease Variable Variable Variable Probable decrease [78][79][80] Daily assessment of readiness to wean Decrease Decrease Decrease Decrease Possible decrease [82] Daily interruption of sedation…”

Section: Variable No Impact No Impact No Impactmentioning

confidence: 99%

“…For example, Ely and colleagues showed that daily, structured evaluations of patients' readiness to wean decreased the median duration of mechanical ventilation by 1.5 days compared with usual care [82]. Likewise, daily interruption in continuous infusion sedatives (titrated to patient wakefulness) shortened the median duration of mechanical ventilation by 2.4 days and the median intensive care length of stay by 3.5 days [83].…”

Section: Ventilator Weaning and Extubation Protocolsmentioning

confidence: 99%

See 1 more Smart Citation

Prevention of ventilator-associated pneumonia

Klompas¹

2010

Expert Review of Anti-infective Therapy

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Section: Variable No Impact No Impact No Impactmentioning

confidence: 99%

Section: Ventilator Weaning and Extubation Protocolsmentioning

confidence: 99%

Prevention of ventilator-associated pneumonia

Klompas¹

2010

Expert Review of Anti-infective Therapy

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“…In these studies, the non-use of protocol has made the time of extubation become inaccurate, resulting in early extubation and unnecessary prolongation of the duration of the weaning process [5,6,13,[16][17][18][19][20][21][22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Efeitos da aplicação de protocolo de desmame de ventilação mecânica em Unidade Coronária: estudo randomizado

Piotto¹,

Maia²,

Machado³

et al. 2011

Rev Bras Cir Cardiovasc

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“…2 Weaning accounts for 41% and 60% of the total ventilatory time in mixed, medicalsurgical ICU populations and in populations with chronic obstructive pulmonary disease (COPD), respectively. 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.…”

Section: Résumémentioning

confidence: 99%

“…Compared with traditional care, protocols have been shown to decrease the time to ventilator discontinuation and the total duration of mechanical support. [4][5][6] However, many barriers exist to implementing weaning protocols in clinical practice. 13,14 Despite the wide use of mechanical ventilation and the recent proliferation of studies on mechanical ventilation discontinuation strategies, little is known about methods of discontinuing mechanical ventilation in clinical practice.…”

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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Effect on the Duration of Mechanical Ventilation of Identifying Patients Capable of Breathing Spontaneously

Cited by 1,227 publications

References 29 publications

Prevention of ventilator-associated pneumonia

Prevention of ventilator-associated pneumonia

Efeitos da aplicação de protocolo de desmame de ventilação mecânica em Unidade Coronária: estudo randomizado

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

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