Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support
CHEST JournalPublished 1 December 2001
Neil R. MacIntyre
Citations1,231
SJR quartileQ1
SJR score1.83
SNIP1.83
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The Discontinuing Ventilatory Support : A Evidence-Based Guidelines for Weaning and http://chestjournal.org services can be found online on the World Wide Web at: The online version of this article, along with updated information and ).
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Agency for Healthcare Policy and Research
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Medicine
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Two new indexes are developed: the first quantitates rapid shallow breathing as the ratio of respiratory frequency to tidal volume (f/VT), and the second is termed CROP, because it integrates thoracic compliance, respiratory ṟate, arterial oxygenation, and P1max.
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1,317 Citations1996E. Wesley Ely, Albert Baker +8 more
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The American Journal of MedicineComplications and consequences of endotracheal intubation and tracheotomy
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The value of tracheotomy when an artificial airway is required for periods as long as three weeks is not supported by data obtained in this study.
American Journal of Respiratory and Critical Care MedicineComparison of Three Methods of Gradual Withdrawal from Ventilatory Support During Weaning from Mechanical Ventilation
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926 Citations1998Marin H. Kollef, Nat T. Levy +4 more
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CHEST JournalEffect of Failed Extubation on the Outcome of Mechanical Ventilation
871 Citations1997Scott K. Epstein, Ronald L. Ciubotaru +1 more
Identifying patients at risk for poor outcomes from extubation failure and instituting alternative care practices may reduce mortality, duration of ICU stay, and need for transfer to a long-term care facility.
Critical Care MedicineA randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation
840 Citations1997Marin H. Kollef, Steven D. Shapiro +7 more
Protocol-guided weaning of mechanical ventilation, as performed by nurses and respiratory therapists, is safe and led to extubation more rapidly than physician-directed weaning.
American Journal of Respiratory and Critical Care MedicineExtubation Outcome after Spontaneous Breathing Trials with T-Tube or Pressure Support Ventilation
816 Citations1997ANDRÉS ESTEBAN, Inmaculada Alía +17 more
Spontaneous breathing trials with pressure support or T-tube are suitable methods for successful discontinuation of ventilator support in patients without problems to resume spontaneous breathing.
American Journal of Respiratory and Critical Care MedicineEffect of Spontaneous Breathing Trial Duration on Outcome of Attempts to Discontinue Mechanical Ventilation
782 Citations1999ANDRÉS ESTEBAN, Inmaculada Alía +11 more
After a first trial of spontaneous breathing, successful extubation was achieved equally effectively with trials targeted to last 30 and 120 min.
Annals of Internal MedicinePulmonary Aspiration of Gastric Contents in Patients Receiving Mechanical Ventilation: The Effect of Body Position
724 Citations1992Antoni Torres, Joan Serra-Batllés +6 more
The supine position and length of time the patient is kept in this position are potential risk factors for aspiration of gastric contents and Elevating the head of the bed for patients who can tolerate the semirecumbent position may be a simple, no-cost prophylactic measure.
New England Journal of MedicineThe Respiratory Muscles
704 Citations1982Charis Roussos, Peter T. Macklem
A large number of patients with asthma have trouble controlling their coughing and wheezing, and the use of steroids to treat these problems is a natural application of steroids.
PubMedOccult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction: the auto-PEEP effect.
673 Citations1982P. Pepe, John J. Marini
Although not apparent during normal ventilator operation, the auto-PEEP effect can be detected and quantified by a simple bedside maneuver: expiratory port occlusion at the end of the set exhalation period.
Annals of Internal MedicineNoninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease
669 Citations1998Stefano Nava, Nicolino Ambrosino +7 more
The aim of this multicenter, randomized study was to evaluate the effectiveness of a new weaning approach in patients with chronic obstructive pulmonary disease, which consisted of 24 to 48 hours of traditional ventilation delivered through an endotracheal tube followed by noninvasive pressure support ventilation.
Journal of Applied PhysiologyEffect of pressure and timing of contraction on human diaphragm fatigue
641 Citations1982F. Bellemare, A. Grassino
The relationship between the mean transdiaphragmatic pressure swing developed with each inspiration (Pdi) and the fraction of the breathing cycle time spent in inspiration (TI/Ttot) was related to the maximal time that such a run could be sustained (Tlim).
American Journal of Respiratory and Critical Care MedicineIndependent Effects of Etiology of Failure and Time to Reintubation on Outcome for Patients Failing Extubation
605 Citations1998Scott K. Epstein, Ronald L. Ciubotaru
The high mortality for those reintubated for nonairway problems indicate that efforts should be preferentially focused on identifying these patients, and the effect of time to reintubsation suggests that identification of patients early after extubation and timely reinstitution of ventilatory support has the potential to reduce the increased mortality associated withextubation failure.
CHEST JournalCriteria for Extubation and Tracheostomy Tube Removal for Patients With Ventilatory Failure
563 Citations1996John R. Bach, Lou Saporito
It is concluded that the ability to generate PCF of at least 160 L/min is necessary for the successful extubation or tracheostomy tube decannulation of patients with neuromuscular disease irrespective of ability to breathe.
AnesthesiologyAcute Left Ventricular Dysfunction during Unsuccessful Weaning from Mechanical Ventilation
555 Citations1988François Lemaire, Jean–Louis Teboul +6 more
Nine of the 15 patients with severe chronic obstructive pulmonary disease and cardiovascular disease were weaned successfully from mechanical ventilation with unchanged PAOP, and transmural pulmonary artery occlusion pressure markedly increased, mandating a reinstitution of MV.
American Journal of Respiratory and Critical Care MedicineImplications of Extubation Delay in Brain-Injured Patients Meeting Standard Weaning Criteria
547 Citations2000William M. Coplin, David J. Pierson +3 more
This study does not support delaying extubating patients when impaired neurologic status is the only concern prolonging intubation, and a randomized trial of extubation at the time brain-injured patients fulfill standard weaning criteria is justifiable.
BrainCRITICAL ILLNESS POLYNEUROPATHY
531 Citations1987Douglas W. Zochodne, Charles F. Bolton +5 more
The studies suggest that the mechanism may be a fundamental defect, still unknown, which causes dysfunction of all organ systems in this syndrome, and indicates that survivors recovered from the polyneuropathy three to six months following discharge.
Journal of Applied PhysiologyImpact of PEEP on lung mechanics and work of breathing in severe airflow obstruction
506 Citations1988Thomas C. Smith, John J. Marini
Low levels of PEEP may improve lung mechanics and reduce the effort required of mechanically ventilated patients with severe airflow obstruction, without substantially increasing the hazards of hyperinflation.
New England Journal of MedicineEffect of Hypophosphatemia on Diaphragmatic Contractility in Patients with Acute Respiratory Failure
503 Citations1985Michel Aubier, D Murciano +5 more
The results strongly suggest that hypophosphatemia impairs the contractile properties of the diaphragm during acute respiratory failure, and they emphasize the importance of maintaining normal serum inorganic phosphate levels in such patients.
The American Journal of MedicineClinical manifestations of inspiratory muscle fatigue
501 Citations1982Carol Cohen, Gary L. Zagelbaum +3 more
The abnormalities of respiratory movements may be reliable clinical signs of inspiratory muscle fatigue, particularly when accompanied by tachypnea and hypercapnia.
New England Journal of MedicinePersistent Paralysis in Critically Ill Patients after Long-Term Administration of Vecuronium
499 Citations1992Veronica Segredo, James E. Caldwell +4 more
Prolonged neuromuscular blockade after the termination of long-term treatment with vecuronium is associated with metabolic acidosis, elevated plasma magnesium concentrations, female sex, and probably more important, the presence of renal failure and high plasma concentrations of 3-desacetylveCuronium.
American Journal of Respiratory and Critical Care MedicineClinical Characteristics, Respiratory Functional Parameters, and Outcome of a Two-Hour T-Piece Trial in Patients Weaning from Mechanical Ventilation
491 Citations1998Imma Vallverdú, Núria Calaf +4 more
In this group of patients, the ability to cough and clear respiratory secretions, objectively reflected by MEP, may help in clinical decision-making.
American Review of Respiratory DiseaseContinuous Positive Airway Pressure Reduces Work of Breathing and Dyspnea during Weaning from Mechanical Ventilation in Severe Chronic Obstructive Pulmonary Disease
488 Citations1990Basil J. Petrof, Martin Legaré +3 more
Examination of the effects of continuous positive airway pressure (CPAP) and its ability to reduce the mechanical load imposed by PEEPi on breathing pattern, work of breathing, and dyspnea in seven patients with severe COPD during weaning from mechanical ventilation found inspiring pulmonary resistance and elastance were unaltered by the application of CPAP.
American Journal of Respiratory and Critical Care MedicineCorticosteroids Contribute to Muscle Weakness in Chronic Airflow Obstruction
485 Citations1994M Decramer, L M Lacquet +2 more
In patients with COPD or asthma, respiratory and peripheral muscle strength and steroid treatment are interrelated despite the relatively low doses administered, demonstrating further limitations on the prolonged treatment of chronic airflow obstruction with systemic corticosteroids.
American Journal of Respiratory and Critical Care MedicineThe American–European Consensus Conference on ARDS, Part 2: Ventilatory, Pharmacologic, Supportive Therapy, Study Design Strategies, and Issues Related to Recovery and Remodeling
480 Citations1998Antonio Artigas, Gordon R. Bernard +10 more
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The LaryngoscopeA prospective study of laryngotracheal sequelae in long‐term intubation
467 Citations1984Robert E. Whited
A series of 200 patients having endotracheal intubation between 2 and 24 days were studied prospectively and showed clear trends in survival and morbidity.
American Journal of Respiratory and Critical Care MedicinePathophysiologic Basis of Acute Respiratory Distress in Patients Who Fail a Trial of Weaning From Mechanical Ventilation
462 Citations1997Amal Jubran, Martin J. Tobin
Development of acute respiratory distress during a failed weaning attempt was due to worsening of pulmonary mechanics, which in conjunction with rapid shallow breathing led to inefficient clearance of CO2.
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453 Citations2000Gregory P. Marelich, Susan Murin +4 more
A VMP designed for multidisciplinary use was effective in reducing duration of mechanical ventilatory support without any adverse effects on patient outcome, suggesting that VMPs are highly effective means of improving care, even in university ICUs.
CHEST JournalModes of Mechanical Ventilation and Weaning
441 Citations1994Andrés Esteban, Inmaculada Alía +3 more
Weaning constitutes a large portion of total ventilator time, and thus, measures that expedite the weaning process should markedly decrease the duration of mechanical ventilation.
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CHEST JournalConsensus Conference on Artificial Airways in Patients Receiving Mechanical Ventilation
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A consensus conference was organized by the National Association of Medical Directors of Respiratory Care and the following consensus statements developed by those scientists attending the conference should favorably affect the quality of patient care, suggest areas for future research, and should influence the development of reimbursement policies concerning patients receiving mechanical ventilation through artificial airway tubes.
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391 Citations1996Davy Cheng, Jacek Karski +11 more
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American Journal of Respiratory and Critical Care MedicineNoninvasive Ventilation as a Systematic Extubation and Weaning Technique in Acute-on-Chronic Respiratory Failure: A Prospective, Randomized Controlled Study
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NIV permits earlier removal of the endotracheal tube than with conventional IPSV, and reduces the duration of daily ventilatory support without increasing the risk of weaning failures, in patients with ACRF who are difficult to wean.
PubMedHypermetabolism, organ failure, and metabolic support.
361 Citations1987Cerra Fb
The hypermetabolism organ failure complex remains the predominant reason for both prolonged stay and death in the surgical intensive care unit and there is probably no "magic bullet"; that regimens will probably be time dependent and "multiple drug"; and that the best treatment is prevention.
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343 Citations1990Jorge L. Rodríguez, Steven M. Steinberg +4 more
It is concluded that early tracheostomy has an overall risk equivalent to that of endotracheal intubation and should be considered for patients in the intensive care unit at risk for more than 7 days of intubations.
CHEST JournalBedside Criteria for Discontinuation of Mechanical Ventilation
339 Citations1973Steven A. Sahn, S. Lakshminarayan
The ease with which these measurements can be performed at the bedside and their high degree of predictability make them useful in acute respiratory care.
American Journal of Respiratory and Critical Care MedicineVariability of Patient-Ventilator Interaction With Pressure Support Ventilation in Patients With Chronic Obstructive Pulmonary Disease
334 Citations1995Amal Jubran, W. B. Van de Graaff +1 more
In conclusion, patient-ventilator interactions in patients with COPD are complex, and events in expiration need to be considered in addition to those of inspiration.
American Journal of Respiratory and Critical Care MedicineChanges in the Work of Breathing Induced by Tracheotomy in Ventilator-dependent Patients
331 Citations1999JEAN-LUC DIEHL, Souheil El Atrous +3 more
It is concluded that tracheotomy can substantially reduce the mechanical workload of ventilator-dependent patients and in vitro measurements showed that the cannula reduced the resistive work induced by the artificial airway.
American Journal of Respiratory and Critical Care MedicineLarge Scale Implementation of a Respiratory Therapist– driven Protocol for Ventilator Weaning
310 Citations1999E. Wesley Ely, Patricia A. Bennett +4 more
It is concluded that implementation of a validated weaning strategy is feasible as a TDP without daily supervision from a weaning physician or team and improved compliance with this large-scale weaning protocol can be achieved.
American Journal of Respiratory and Critical Care MedicineThe Tension–Time Index and the Frequency/ Tidal Volume Ratio Are the Major Pathophysiologic Determinants of Weaning Failure and Success
297 Citations1998Theodoros Vassilakopoulos, Spyros Zakynthinos +1 more
It is concluded that the TTI and the f/VT are the major pathophysiologic determinants underlying the transition from weaning failure to weaning success.
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286 Citations1989Gene Colice, Thérèse A. Stukel +1 more
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285 Citations1997Rafael Barrientos-Vega, M. Mar Sánchez-Soria +4 more
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New England Journal of MedicineVentilatory Control in Myxedema and Hypothyroidism
284 Citations1975Clifford W. Zwillich, David J. Pierson +3 more
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American Journal of Respiratory and Critical Care MedicineContinuous Recordings of Mixed Venous Oxygen Saturation during Weaning from Mechanical Ventilation and the Ramifications Thereof
278 Citations1998Amal Jubran, M. Mathru +2 more
Multicenter, Randomized, Prospective Trial of Early Tracheostomy
274 Citations1997Harvey J. Sugerman, Luke G. Wolfe +7 more
There were no significant differences in ICU LOS, frequency of pneumonia, or death in any of the groups after either early or late tracheostomy compared with continued endotracheal intubation, and the Glasgow Coma Scale score, Emergency Room Trauma Score, Injury Severity Score, Acute Injury Score, positive end-expiratory pressure, and peak inspiratory pressure were not significantly different in the groups.
American Journal of Respiratory and Critical Care MedicineEffects of Mechanical Ventilation on Diaphragmatic Contractile Properties in Rats
273 Citations1994Geneviève Le Bourdellés, N. Viirès +4 more
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American Journal of Respiratory and Critical Care MedicineOutcomes after Long-Term Acute Care: An Analysis of 133 Mechanically Ventilated Patients
264 Citations1999Shannon S. Carson, Peter B. Bach +2 more
Characteristics predicting the poorest prognoses for patients requiring prolonged mechanical ventilation are demonstrated and may be identifiable before transfer to an LTAC hospital.
American Review of Respiratory Disease<i>In Vitro</i> versus <i>In Vivo</i> Comparison of Endotracheal Tube Airflow Resistance
259 Citations1989Patrick E. Wright, J. J. Marini +1 more
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CHEST JournalAssociation Between Reduced Cuff Leak Volume and Postextubation Stridor
257 Citations1996Rachel L. Miller, Randolph P. Cole
A reduced cuff leak volume prior to extubation identifies a population at increased risk for postextubation stridor.
American Journal of Respiratory and Critical Care MedicineEtiology of Extubation Failure and the Predictive Value of the Rapid Shallow Breathing Index
255 Citations1995S. Epstein
This study confirms the high PPV for an f/VT < 100 and defines the etiology of the 20% false-positive rate (FPR), which is best explained by extubation failure caused by processes for which f/ VT is physiologically or temporally unlikely to predict success or failure.
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The results suggest that, where O2 transport is compromised, artificial ventilation may release substantial quantities of oxygen for use by other body systems.
CHEST JournalPredicting the Duration of Mechanical Ventilation
234 Citations1996Michael G. Seneff, Jack E. Zimmerman +3 more
An equation developed using multivariate regression techniques can accurately predict average duration of ventilation for groups of ICU patients, and it is believed this equation will be useful for comparing ventilator practices between ICUs, controlling for patient differences in clinical trials of new therapies or weaning techniques, and as a quality improvement mechanism.
American Review of Respiratory DiseaseExternal Work Output and Force Generation during Synchronized Intermittent Mechanical Ventilation: Effect of Machine Assistance on Breathing Effort
230 Citations1988John J. Marini, Thomas C. Smith +1 more
Little effort adaptation to volume-cycled machine assistance appears to occur on a breath-by-breath basis, and under the conditions of this study the ventilatory pump continued to be active at all levels of machine assistance.
American Journal of Respiratory and Critical Care MedicineCycling of Inspiratory and Expiratory Muscle Groups with the Ventilator in Airflow Limitation
230 Citations1998Sairam Parthasarathy, Amal Jubran +1 more
The continuation of mechanical inflation into neural expiration was associated with failure of the subsequent inspiratory attempt to trigger the ventilator.
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A decreased metabolic rate has been associated with decreased ventilatory response to hypoxia and hypercapnia, and also with starvation, and the decrease seen during semi-starvation may contribute to the hypoxemia and respiratory failure subsequent to caloric restriction.
Acta Physiologica ScandinavicaNeural control in human muscle fatigue: changes in muscle afferents, moto neurones and moto cortical drive
222 Citations1998Simon C. Gandevia
There is a need to study the reflex effects on moto neurones and the excitability of the moto cortex in experimental animals, as well as to apply rigorous methods to assess these processes in voluntary exercise in human subjects.
The Pediatric Infectious Disease JournalPatient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit
219 Citations1997Lennox K. Archibald, Mary Lou Manning +3 more
The NIR was most strongly correlated with patient census but also was strongly associated with the nursing hours:patient day ratio, which may influence the infection rate because of breaks in health care worker aseptic technique or decreased hand washing.
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219 Citations1998Martin J. Tobin, Christoph Tang +18 more
A comprehensive text covering all aspects of monitoring in the intensive care unit (ICU) and includes reviews of equipment, instrumentation, numerical values, indications and quality control.
Intensive Care MedicineThe American-European consensus conference on ARDS, Part 2
217 Citations1998Antonio Artigas, Gordon R. Bernard +10 more
The American-European Consensus Committee on ARDS was formed to re-evaluate the standards for the ICU care of patients with acute lung injury (ALI), with regard to ventilatory strategies, the more promising pharmacologic agents, and the definition and quantification of pathological features of ALI that require resolution.
Journal of Applied PhysiologyCoordination between rib cage muscles and diaphragm during quiet breathing in humans
208 Citations1984André De Troyer, Marc Estenne
The pattern of activation of the scalenes and the parasternal intercostal muscles was studied in relation to the pattern of rib cage and abdominal motion during various respiratory maneuvers in the tidal volume range in five normal humans.
American Journal of Respiratory and Critical Care MedicineContribution of the Endotracheal Tube and the Upper Airway to Breathing Workload
205 Citations1998Christian Straus, Bruno Louis +4 more
It is concluded that a 2-h trial of spontaneous breathing through an endotracheal tube well mimics the work of breathing performed after extubation, in patients who pass a weaning trial and do not require reintubation.
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200 Citations1995Franco Laghi, Nausica D’Alfonso +1 more
In conclusion, induction of diaphragmatic fatigue with this experimental protocol produced a marked decrease in diaphagmatic contractility that persisted for at least 24 h.
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198 Citations1987C. S. Sassoon, T T Te +2 more
It is concluded that P0.1 is an important indicator for successful weaning during discontinuation of assisted ventilation in patients with chronic obstructive pulmonary disease and Tachypnea was not useful in predicting failure to wean.
American Review of Respiratory DiseaseAssessment of Diaphragm Weakness
196 Citations1988Anne Mier-Jedrzejowicz, C. Brophy +2 more
Critical Care MedicinePerioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery
195 Citations1999Mohamed Y. Rady, Thomas Ryan
Extubation failure prolonged the length of total mechanical ventilation, as well as ICU and hospital stay, independent of the frequency of organ dysfunction or nosocomial infections but did not increase the risk of death after cardiac surgery.
The Journal of Trauma: Injury, Infection, and Critical CareProlonged Tracheal Intubation in the Trauma Patient
195 Citations1984C. Michael Dunham, CONNIE LaMONICA
It is concluded that patients can undergo translaryngeal intubation for up to 2 weeks without significantly increasing complications relative to transtracheal intubiation.
The LaryngoscopeProlonged intubation <i>vs.</i> tracheotomy: Complications, practical and psychological considerations
194 Citations1988David I. Astrachan, J. Cameron Kirchner +1 more
The charts of 52 adult patients who underwent tracheotomy (49 after intubation) were reviewed to identify early complications of both endotracheal intubations and tracheotomies.
American Review of Respiratory DiseaseNeuromuscular Blockade in the Intensive Care Unit: More than We Bargained for
193 Citations1993John Hansen‐Flaschen, Jay Cowen +1 more
PubMedMass loading, sleep apnea, and the pathogenesis of obesity hypoventilation.
183 Citations1982Melvin Lopata, Ergün Önal
It is concluded that both OSA and OH patients were equally unable to develop the expected increase in respiratory muscle drive and output and the presence of sleep apnea may result in impaired mass load compensation and predispose obese patients to develop hypercapnia.
Critical Care MedicinePredictors of extubation success and failure in mechanically ventilated infants and children
181 Citations1996Nadeem Khan, Andrew Brown +1 more
Bedside measurements of respiratory function can predict extubation success and failure in infants and children and both a low risk and a high risk of failure can be determined using these measures.
Journal of Applied PhysiologyDoes rib cage-abdominal paradox signify respiratory muscle fatigue?
176 Citations1987Martin J. Tobin, William Quintero Pérez +3 more
Results in healthy subjects breathing against severe resistances indicate that RC-Ab asynchrony and paradox and variation in compartmental contribution to tidal volume are predominantly due to increases in respiratory load rather than muscle fatigue.
Annals of Internal MedicineGastric Intramural pH as a Predictor of Success or Failure in Weaning Patients from Mechanical Ventilation
172 Citations1993Zab Mohsenifar, Angela Hay +3 more
The hypothesis that gastric pHi can be used as a rapid indicator of blood-flow diversion from the splanchnic bed in patients in whom the demands of the respiratory pump during weaning trials are excessive or who have inadequate oxygen delivery to meet these demands is tested.
CHEST JournalPost-ICU Mechanical Ventilation
170 Citations1997David J. Scheinhorn, David C. Chao +3 more
Patients are being transferred from the ICU to the RWC for attempted weaning sooner in their course of PMV, and survival after RWC discharge is improved, although more severely ill on arrival than in past years.
American Review of Respiratory DiseaseAirway Occlusion Pressure and Breathing Pattern as Predictors of Weaning Outcome
168 Citations1993Catherine S. H. Sassoon, C. Kees Mahutte
Airway occlusion pressure (P0.1) and the ratio of breathing frequency (f) to tidal volume (VT) (f/Vt) are good predictors of weaning outcome, but the specificity of f/VT in predicting weaning success is relatively low.
Critical Care MedicineAdditional work of breathing imposed by endotracheal tubes, breathing circuits, and intensive care ventilators
167 Citations1989Andrew D. Bersten, Albert J. Rutten +2 more
Spontaneous breathing through modern ventilators, circuits and ETT imposes a burden of increased work, most of which is associated with the presence of the ETT and connector, whether this burden represents an impediment to the weaning patient, or has training value for the ultimate resumption of unassisted spontaneous ventilation, remains to be determined.
Critical Care MedicineInfluence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease
163 Citations1995Jean-Benoît Thorens, Rainer M. Kaelin +2 more
The quality of nursing appears to be a measurable and critical factor in the weaning from mechanical ventilation of patients with chronic obstructive pulmonary disease, below a threshold in the available workforce of ICU nurses.
Archives of SurgeryChanges in Respiratory Mechanics After Tracheostomy
163 Citations1999Kenneth A. Davis
It is believed that the rigid nature of the tracheostomy tube represents reduced imposed WOB compared with the longer, thermoliable endotracheal tube and in patients in whom extubation failed, WOB may be elevated because of incomplete control of the upper airway.
Journal of Parenteral and Enteral NutritionEffect of Nutritional Support on Weaning Patients Off Mechanical Ventilators
161 Citations1981Hosni R. Bassili, Mervyn Deitel
The provision of adequate nutritional support to ventilator patients (VP), although important, is still overlooked in many hospitals and this was likely highly significant in surgical patients because of greater metabolic demand for wound healing and more severe sepsis.
Critical Care MedicinePerioperative complications of elective tracheostomy in critically ill patients
158 Citations1986M. Stock, CAMILLE G. WOODWARD +4 more
This study was designed to examine prospectively the incidence of perioperative complications associated with elective tracheostomy in critically ill patients and found no loss of airway in 81 procedures.
American Journal of Respiratory and Critical Care MedicineClinical Evaluation of a Computer-controlled Pressure Support Mode
157 Citations2000Michel Dojat, A. Harf +3 more
Automatic PSV increased the time spent within desired ventilation parameter ranges and apparently reduced periods of excessive workload.
CHEST JournalOcclusion Pressure and Its Ratio to Maximum Inspiratory Pressure Are Useful Predictors for Successful Extubation Following T-Piece Weaning Trial
156 Citations1995Xavier Capdevila, P.-F. Perrigault +3 more
PO.1 and PO.1/MIP ratio provide the best means of predicting extubation success, and they are not influenced by tracheal tube resistance.
AnaesthesiaThe ‘cuff‐leak’ test for extubation
148 Citations1992M. McD. Fisher, Raymond F. Raper
A failed cuff‐leak test does not preclude uneventful extubation and if used as a criterion forextubation may lead to unnecessarily prolonged intubation or to unnecessary tracheostomy.
PubMedPostoperative respiratory care: a controlled trial of early and late extubation following coronary-artery bypass grafting.
148 Citations1980Arthur L. Quasha, Nancy Loeber +3 more
PubMedThe role of early tracheostomy in blunt, multiple organ trauma.
147 Citations1992I. Lesnik, William Rappaport +2 more
It is concluded that early tracheostomy helps in early weaning from the ventilator and reduces the incidence of nosocomial pneumonias and time of mechanical ventilatory support in patients with blunt, multiple organ injury.
American Journal of Respiratory and Critical Care MedicineEvaluation of a Knowledge-Based System Providing Ventilatory Management and Decision for Extubation
145 Citations1996Michel Dojat, A. Harf +4 more
It is concluded that the KBS ensured appropriate patient management during the weaning period and improved the ability to predict responses to weaning.
American Journal of Respiratory and Critical Care MedicineTidal Volume Maintenance During Weaning With Pressure Support
142 Citations1995Randolph W. Stroetz, Rolf D. Hubmayr
It is concluded that the gradual withdrawal of machine support does not facilitate the recognition of impending respiratory failure and Ventilatory response parameters such as the rapid shallow breathing index were of limited value in predicting weaning outcome.
CHEST JournalCardiac Ischemia During Weaning From Mechanical Ventilation
141 Citations1996Wissam Chatila, Salim Ani +4 more
Cardiac ischemia, although infrequent in the general population of weaning medical/cardiac ICU patients, should be considered in patients with CAD who fail to wean.
Journal of Thoracic and Cardiovascular SurgeryClinically relevant diaphragmatic dysfunction after cardiac operations
140 Citations1994Jean‐Luc Diehl, Frédéric Lofaso +4 more
It is concluded that prolonged postoperative diaphragmatic dysfunction may cause severe life-threatening complications after cardiac operation and can be limited to some extent by avoiding the use of iced slush topical cooling of the heart.
CHEST JournalSerial Measurements of the Rapid-Shallow-Breathing Index as a Predictor of Weaning Outcome in Elderly Medical Patients
138 Citations1997Bruce P. Krieger, Jamal Isber +3 more
Serial measurements of the rapid-shallow-breathing index in medical elderly patients during a period of spontaneous breathing can accurately predict the ability to be successfully weaned from mechanical ventilator support.
Journal of Applied PhysiologyEffect of nutritional deprivation on diaphragm contractility and muscle fiber size
136 Citations1986Michael I. Lewis, Gary C. Sieck +2 more
It is concluded that changes in diaphragm contractile and fatigue properties occur as a result of the influence of malnutrition on muscle fiber cross-sectional area.
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