Ventilator Weaning

Publication Title: 
Critical Care Medicine

OBJECTIVE: Because the results of a meta-analysis are used to formulate the highest level recommendation in clinical practice guidelines, clinicians should be mindful of problems inherent in this technique. Rather than reviewing meta-analysis in abstract, general terms, we believe readers can gain a more concrete understanding of the problems through a detailed examination of one meta-analysis.

Author(s): 
Tobin, Martin J.
Jubran, Amal
Publication Title: 
Chest

We found eight randomized controlled trials (RCTs) of miscellaneous interventions that were designed to facilitate the process of weaning from mechanical ventilation. The two RCTs of high-fat/low-carbohydrate enteral nutrition found favorable physiologic effects on CO2 production and respiratory quotient, rendering this type of nutrition potentially useful in patients with impaired ventilatory reserve; however, no conclusions can be made about the outcomes of the duration of ventilation and weaning success.

Author(s): 
Cook, D.
Meade, M.
Guyatt, G.
Butler, R.
Aldawood, A.
Epstein, S.
Publication Title: 
Psychosomatics
Author(s): 
Bowen, D. E.
Publication Title: 
Anesthesiology
Author(s): 
Treggiari-Venzi, M. M.
Suter, P. M.
de Tonnac, N.
Romand, J. A.
Publication Title: 
European Journal of Pediatrics

Mechanically ventilated pediatric intensive care patients usually receive an analgesic and sedative to keep them comfortable and safe. However, common drugs like fentanyl and midazolam have a long context sensitive half time, resulting in prolonged sedation and an unpredictable extubation time. Children often awake slowly and struggle against the respirator, although their respiratory drive and their airway reflexes are not yet sufficient for extubation. In this pilot study, we replaced fentanyl and midazolam at the final phase of the weaning process with remifentanil and propofol.

Author(s): 
Welzing, Lars
Vierzig, Anne
Junghaenel, Shino
Eifinger, Frank
Oberthuer, Andre
Trieschmann, Uwe
Roth, Bernhard
Publication Title: 
Heart & Lung: The Journal of Critical Care

BACKGROUND: Successful liberation from prolonged mechanical ventilation (PMV) is a challenging phenomenon. Whereas many physiological factors have been linked to successful PMV liberation, the psychosocial components are not well delineated. OBJECTIVES: This article serves to describe the experience of patients who survived PMV and to identify salient factors that contributed to successful liberation. METHODS: A phenomenological approach was used to explore the lived experience of seven PMV survivors.

Author(s): 
Arslanian-Engoren, Cynthia
Scott, Linda D.
Publication Title: 
Heart & Lung: The Journal of Critical Care

BACKGROUND: Successful liberation from prolonged mechanical ventilation (PMV) is a challenging phenomenon. Whereas many physiological factors have been linked to successful PMV liberation, the psychosocial components are not well delineated. OBJECTIVES: This article serves to describe the experience of patients who survived PMV and to identify salient factors that contributed to successful liberation. METHODS: A phenomenological approach was used to explore the lived experience of seven PMV survivors.

Author(s): 
Arslanian-Engoren, Cynthia
Scott, Linda D.
Publication Title: 
JAMA

CONTEXT: The omega-3 (n-3) fatty acids docosahexaenoic acid and eicosapentaenoic acid, along with γ-linolenic acid and antioxidants, may modulate systemic inflammatory response and improve oxygenation and outcomes in patients with acute lung injury. OBJECTIVE: To determine if dietary supplementation of these substances to patients with acute lung injury would increase ventilator-free days to study day 28. DESIGN, SETTING, AND PARTICIPANTS: The OMEGA study, a randomized, double-blind, placebo-controlled, multicenter trial conducted from January 2, 2008, through February 21, 2009.

Author(s): 
Rice, Todd W.
Wheeler, Arthur P.
Thompson, B. Taylor
deBoisblanc, Bennett P.
Steingrub, Jay
Rock, Peter
NIH NHLBI Acute Respiratory Distress Syndrome Network of Investigators
NHLBI ARDS Clinical Trials Network
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