Weaning Patients from the Ventilator

McConville, John F.; Kress, John P.

doi:10.1056/nejmra1203367

Cited by 224 publications

(175 citation statements)

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“…Removing patients from ventilator support is termed "weaning," and the incidence of difficult weaning varies between different ICUs but can reach the level of ϳ30% of patients exposed to prolonged MV (28,71). The inability to wean patients from the ventilator results in extended hospital stays and increases morbidity and mortality (27).…”

Section: Contribution Of Vidd To Weaning Failurementioning

confidence: 99%

“…The causes of weaning failure can be multifactorial and include aspects such as medications (e.g., neuromuscular blockers), confounding morbidities (e.g., sepsis), psychological factors (i.e., anxiety), neurological disorders, and an imbalance between respiratory load and the respiratory muscle capacity (26,43,71,115). Although controversy exists, it has been predicted that depressed strength and endurance of respiratory muscles can play a key role in weaning difficulties (26,34,115).…”

Section: Contribution Of Vidd To Weaning Failurementioning

confidence: 99%

See 1 more Smart Citation

Ventilator-induced diaphragm dysfunction: cause and effect

Powers

Wiggs

Sollanek

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

143

156

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Powers SK, Wiggs MP, Sollanek KJ, Smuder AJ. Ventilator-induced diaphragm dysfunction: cause and effect. Am J Physiol Regul Integr Comp Physiol 305: R464 -R477, 2013. First published July 10, 2013 doi:10.1152/ajpregu.00231.2013 is used clinically to maintain gas exchange in patients that require assistance in maintaining adequate alveolar ventilation. Common indications for MV include respiratory failure, heart failure, drug overdose, and surgery. Although MV can be a life-saving intervention for patients suffering from respiratory failure, prolonged MV can promote diaphragmatic atrophy and contractile dysfunction, which is referred to as ventilator-induced diaphragm dysfunction (VIDD). This is significant because VIDD is thought to contribute to problems in weaning patients from the ventilator. Extended time on the ventilator increases health care costs and greatly increases patient morbidity and mortality. Research reveals that only 18 -24 h of MV is sufficient to develop VIDD in both laboratory animals and humans. Studies using animal models reveal that MV-induced diaphragmatic atrophy occurs due to increased diaphragmatic protein breakdown and decreased protein synthesis. Recent investigations have identified calpain, caspase-3, autophagy, and the ubiquitin-proteasome system as key proteases that participate in MV-induced diaphragmatic proteolysis. The challenge for the future is to define the MV-induced signaling pathways that promote the loss of diaphragm protein and depress diaphragm contractility. Indeed, forthcoming studies that delineate the signaling mechanisms responsible for VIDD will provide the knowledge necessary for the development of a pharmacological approach that can prevent VIDD and reduce the incidence of weaning problems. respiratory muscle; atrophy; mechanical ventilation; weaning; muscle wasting MECHANICAL VENTILATION (MV) is used clinically to achieve sufficient pulmonary gas exchange in patients unable to sustain adequate alveolar ventilation on their own. Common indications for MV include respiratory failure due to chronic obstructive pulmonary disease, status asthmaticus, and/or heart failure. In addition, MV is often an essential intervention in patients suffering from acute drug overdose, neuromuscular diseases, sepsis, and during surgery along with postsurgical recovery.The number of patients receiving prolonged MV in the United States exceeds more than 300,000 each year in the intensive care unit (ICU) (20). Although MV can be a lifesaving measure, prolonged MV results in the rapid development of diaphragmatic weakness due to both atrophy and contractile dysfunction. This detrimental impact of prolonged MV on the diaphragm has been termed ventilator-induced diaphragmatic dysfunction (VIDD) and VIDD is predicted to be a major contributor to problems in weaning patients from the ventilator (26, 114). Although previous reports describing the impact of prolonged MV on the diaphragm have appeared in the literature, advances in our understanding of the mechanisms responsible for VIDD h...

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Section: Contribution Of Vidd To Weaning Failurementioning

confidence: 99%

Section: Contribution Of Vidd To Weaning Failurementioning

confidence: 99%

Ventilator-induced diaphragm dysfunction: cause and effect

Powers

Wiggs

Sollanek

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

143

156

View full text Add to dashboard Cite

show abstract

“…[21][22][23] • Consideración diaria de retiro del respirador, evaluando si el paciente se encontraba en condiciones de realizar una prueba de respiración espontánea. 24,25 • Consideración diaria de retiro del catéter central.…”

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Implementación de una lista de cotejo para mejorar la adherencia a prácticas basadas en evidencia en una Unidad de Cuidados Intensivos Pediátricos

et al. 2017

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“…8 Efforts are also directed to discontinuing mechanical ventilation and promptly extubating patients once endotracheal intubation is no longer required. 9 Although these strategies are well described and usually an integral part of mechanical ventilation, strategies to minimize unplanned extubation are poorly understood or implemented. 10 Many researchers have studied risk factors and opportunities for interventions to prevent unplanned extubation, but the effects of various sedation strategies on unplanned extubation have not been compared.…”

mentioning

confidence: 99%

Influence of Sedation Strategies on Unplanned Extubation in a Mixed Intensive Care Unit

Tanios¹,

Epstein²,

Grzeskowiak³

et al. 2014

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Define unplanned extubation. 2. Explain possible causes of unplanned extubation. 3. Identify the relationship between sedation strategy and unplanned extubation. Results A total of 92 unplanned extubations occurred (7.5 events/1000 days of mechanical ventilation): patients who were receiving continuous sedation protocol with daily interruption of sedatives had 1.5 events/1000 ventilator days, patients receiving the intermittent sedation protocol had 5.0 events/1000 days, and patients with no sedation protocol had 16 events/1000 days (P < .05). Median duration of mechanical ventilation before unplanned extubation was 2 days. Most unplanned extubations (94%) were deliberate, and 53% occurred in patients scheduled for weaning. Most unplanned extubations in the continuous sedation protocol group (71%) occurred during weaning, in comparison to the intermittent sedation protocol (54%) and no sedation protocol groups (48%, P < .05). The highest incidences of agitation were in patients receiving the intermittent sedation protocol as compared with the other 2 groups (77% vs 50% vs 49%, P < .05). Overall, 73% of patients who had an unplanned extubation did not require reintubation; those who did were older (mean age: 68 vs 53 years, P = .01) and were male (80% vs 20%, P = .02). Reintubation was unrelated to the time of unplanned extubation. Conclusion Strategies of no sedation or intermittent sedation are both associated with higher rates of unplanned extubation when compared to a strategy of continuous sedation with daily interruption of sedatives. Sedation strategies that allow agitation may increase the risk of unplanned extubation.

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Weaning Patients from the Ventilator

Cited by 224 publications

References 50 publications

Ventilator-induced diaphragm dysfunction: cause and effect

Ventilator-induced diaphragm dysfunction: cause and effect

Implementación de una lista de cotejo para mejorar la adherencia a prácticas basadas en evidencia en una Unidad de Cuidados Intensivos Pediátricos

Influence of Sedation Strategies on Unplanned Extubation in a Mixed Intensive Care Unit

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