Skip to main content

Liberating Patients from Mechanical Ventilation: What Have We Learned About Protocolizing Care?

  • Conference paper
Mechanical Ventilation

Part of the book series: Update in Intensive Care Medicine ((UICMSOFT))

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Hess DR (2002) Liberation from mechanical ventilation: Weaning the patient or weaning old-fashioned ideas? Crit Care Med 30:2154–2155

    PubMed  Google Scholar 

  2. MacIntyre NR, Cook DJ, Ely EW, et al (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support a collective task force facilitated by the american college of chest physicians; the american association for respiratory care; and the american college of critical care medicine. Chest 120(suppl):375S–395S

    PubMed  CAS  Google Scholar 

  3. Krieger BP (2002) Top ten list in mechanical ventilation. Chest 122:1797–1800

    PubMed  Google Scholar 

  4. Tobin MJ (2001) Advances in mechanical ventilation. N Engl J Med 344:1986–1996

    Article  PubMed  CAS  Google Scholar 

  5. Esteban A, Alia I, Ibanez J, Benito S, Tobin MJ (1994) The Spanish Lung Failure Collaborative Group, Modes of mechanical ventilation and weaning. Chest 106:1188–1193

    PubMed  CAS  Google Scholar 

  6. Esteban A, Anzueto A, Frutos F, et al (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation a 28-day international study. JAMA 287:345–355

    Article  PubMed  Google Scholar 

  7. Stroetz RW, Hubmayr RD (1995) Tidal volume maintenance during weaning with pressure support. Am J Respir Crit Care Med 152:1034–1040

    PubMed  CAS  Google Scholar 

  8. Listello D, Sessler C (1994) Unplanned extubation: clinical predictors for reintubation. Chest 105:1496–1503

    PubMed  CAS  Google Scholar 

  9. Tindol GA, Jr., DiBenedetto RJ, Kosciuk L (1994) Unplanned extubations. Chest 105:1804–1807

    PubMed  Google Scholar 

  10. Boulain T, and the Association des Reanimateurs du Centre-Ouest (1998) Unplanned extubations in the adult intensive care unit: a prospective multicenter study. Am J Respir Crit Care Med 157:1131–1137

    PubMed  CAS  Google Scholar 

  11. Betbese AJ, Perez M, Rialp G, et al (1998) A prospective study of unplanned endotracheal extubation in intensive care unit patients. Crit Care Med 26:1180–1186

    PubMed  CAS  Google Scholar 

  12. Khamiees M, Raju P, Amoateng-Adjepong Y, Manthous CA (2001) Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 120:1262–1270

    Article  PubMed  CAS  Google Scholar 

  13. Ely EW, Bennett PA, Bowton DL, et al (1999) Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning. Am J Respir Crit Care Med 159:439–446

    PubMed  CAS  Google Scholar 

  14. Laghi F, Cattapan SE, Jubran A, et al (2003) Is weaning failure caused by low-frequency fatigue of the diaphragm? Am J Respir Crit Care Med 167:120–127

    Article  PubMed  Google Scholar 

  15. Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 324:1445–1450

    Article  PubMed  CAS  Google Scholar 

  16. Hoo GW, Park L (2002) Variations in the measurement of weaning parameters: a survey of respiratory therapists. Chest 121:1947–1955

    Google Scholar 

  17. Sahn SA, Lakshminarayan S (1973) Bedside criteria for discontinuation of mechanical ventilation. Chest 63:1002–1005

    PubMed  CAS  Google Scholar 

  18. Brochard L, Rauss A, Benito S, et al (1994) Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150:896–903

    PubMed  CAS  Google Scholar 

  19. Esteban A, Frutos F, Tobin MJ, et al (1995) A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 332:345–350

    Article  PubMed  CAS  Google Scholar 

  20. Ely EW, Baker AM, Dunagan DP, et al (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335:1864–1869

    Article  PubMed  CAS  Google Scholar 

  21. Wood KE, Flaten AL, Reedy JS, Coursin DB (1999) Use of a daily screen and weaning protocol for mechanically ventilated patients in a multidisciplinary tertiary critical care unit. Crit Care Med 27:A94–A94

    Google Scholar 

  22. Kollef MH, Shapiro SD, Silver P, et al (1997) A randomized, controlled trial of protocol-directed versus physician-directed weaning from Mechanical Ventilation. Crit Care Med 25:567–574

    PubMed  CAS  Google Scholar 

  23. Strickland JH Jr, Hasson JH (1993) Acomputer-controlled ventilator weaning system: a clinical trial. Chest 103:1220–1226

    PubMed  Google Scholar 

  24. Marelich GP, Murin S, Battistella F, et al (2000) Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: Effect on weaning time and incidence of ventilator-associated pneumonia. Chest 118:459–467

    Article  PubMed  CAS  Google Scholar 

  25. Foster GH, Conway WA, Pamulkov N, et al (1984) Early extubation after coronary artery bypass: brief report. Crit Care Med 12:994–996

    PubMed  CAS  Google Scholar 

  26. Tong DA (1991) Weaning patients from mechanical ventilation. A knowledge-based system approach. Comput Methods Programs Biomed 35:267–278

    Article  PubMed  CAS  Google Scholar 

  27. Rotello LC, Warren J, Jastremski MS, et al (1992) A nurse-directed protocol using pulse oximetry to wean mechanically ventilated patients from toxic oxygen concentrations. Chest 102:1833–1835

    PubMed  CAS  Google Scholar 

  28. Wood G, MacLeod B, Moffatt S (1995) Weaning from mechanical ventilation: physician-directed vs a respiratory-therapist-directed protocol. Respir Care 40:219–224

    PubMed  CAS  Google Scholar 

  29. Saura P, Blanch L, Mestre J, et al (1996) Clinical consequences of the implementation of a weaning protocol. Intensive Care Med 22:1052–1056

    PubMed  CAS  Google Scholar 

  30. Djunaedi H, Cardinal P, Greffe-Laliberte G, et al (1987) Does a ventilatory management protocol improve the care of ventilated patients? Respir Care 42:604–610

    Google Scholar 

  31. Burn SM, Marshall M, Burns JE, et al (1998) Design, testing, and results of an outcomes-managed approach to patients requiring prolonged mechanical ventilation. Am J Crit Care 7:45–57

    Google Scholar 

  32. Horst HM, Mouro D, Hall-Jenssens RA, et al (1998) Decrease in ventilation time with a standardized weaning process. Arch Surg 133:483–488

    PubMed  CAS  Google Scholar 

  33. Kollef MH, Horst HM, Prang L, et al (1998) Reducing the duration of mechanical ventilation: three examples of change in the intensive care unit. New Horiz 6:52–60

    PubMed  CAS  Google Scholar 

  34. Cohen IL, Booth FV (1994) Cost containment and mechanical ventilation in the United States. New Horiz 2:283–290

    PubMed  CAS  Google Scholar 

  35. Cohen IL (1994) Weaning from mechanical ventilation —the team approach and beyond. Intensive Care Med 20:317–318

    Article  PubMed  CAS  Google Scholar 

  36. Smyrnios NA, Connolly A, Wilson MM, et al (2002) Effects of a multifaceted, multidisciplinary, hospital-wide quality improvement program on weaning from mechanical ventilation. Crit Care Med 30:1224–1230

    PubMed  Google Scholar 

  37. Esteban A, Alia I, Tobin M, et al (1999) Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Am J Respir Crit Care Med 159:512–518

    PubMed  CAS  Google Scholar 

  38. Perrren A, Domenighetti G, Mauri S, Genini F, Vizzardi N (2002) Protocol-driven weaning from mechanical ventilation: clinical outcome in patients randomized for a 30-min or 120-min trial with pressure support ventilation. Intensive Care Med 28:1058–1063

    Google Scholar 

  39. Esteban A, Alia I, Gordo F, et al (1997) The Spanish Lung Failure Collaborative Group. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med 156:459–465

    PubMed  CAS  Google Scholar 

  40. Esteban A, Anzueto A, Alia I, et al (2000) How is mechanical ventilation employed in the intensive care unit. Am J Respir Crit Care Med 161:1450–1458

    PubMed  CAS  Google Scholar 

  41. Vitacca M, Vianello A, Colombo D, et al (2001) Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days. Am J Respir Crit Care Med 164:225–230

    PubMed  CAS  Google Scholar 

  42. Iregui M, Ward S, Clinikscale D, Clayton D, Kollef MH (2002) Use of a handheld computer by respiratory care practitioners to improve the efficiency of weaning patients from mechanical ventilation. Crit Care Med 30:2038–2043

    PubMed  Google Scholar 

  43. Croft B (2002) Ventilator weaning protocols. Journal for Respiratory Care Practitioners. Aug/Sept, pp:26–30

    Google Scholar 

  44. Ely EW (2000) The utility of weaning protocols to expedite liberation from mechanical ventilation. Respir Care Clin N Am 6:303–319

    PubMed  CAS  Google Scholar 

  45. Brattebo G, Hofoss D, Flaatten H, Muri AK, Gjerde S, Plsek P (2002) Effect of a scoring system and protocol for sedation on duration of patient’s need for ventilator support in a surgical intensive care unit. Br Med J 324:1386–1389

    Google Scholar 

  46. Main DS, Cohen SJ, DiClemente CC (1995) Measuring physician readiness to change cancer screening: preliminary results. Am J Prev Med 11:54–58

    PubMed  CAS  Google Scholar 

  47. Fridkin SK, Pear SM, Williamson TH, et al (1996) The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 17:150–158

    Article  PubMed  CAS  Google Scholar 

  48. Archibald LK, Manning ML, Bell LM, et al (1997) Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis 16:1045–1048

    CAS  Google Scholar 

  49. Thorens JB, Kaelin RM, Jolliet P, et al (1995) Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. Crit Care Med 23:1807–1815

    PubMed  CAS  Google Scholar 

  50. Damen J, van Diejen D, Bakker J, van Zanten ARH (2003) Legal implications of clinical practice guidelines. Intensive Care Med 29:3–7

    PubMed  Google Scholar 

  51. Jacobi J, Fraser GL, Coursin DB, et al (2002) Clinical practice guidelines for the susstained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–140

    PubMed  Google Scholar 

  52. Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477

    Article  PubMed  CAS  Google Scholar 

  53. Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G (1998) The use of continuous iv sedation is associated with prolongation of mechanical ventilation. Chest 114:541–548

    PubMed  CAS  Google Scholar 

  54. Randolph AG, Wypij D, Venkataraman ST, et al (2002) Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children a randomized controlled trial. JAMA 288:2561–2568

    Article  PubMed  Google Scholar 

  55. O’meade MO, Ely EW (2002) Protocols to improve the care of critically ill pediatric and adult patients. JAMA 288:2601–2603

    Google Scholar 

  56. Mascia MF, Koch M, Medicis JJ (2000) Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care. Crit Care Med 28:2300–2306

    PubMed  CAS  Google Scholar 

  57. Brook AD, Ahrens TS, Schaiff R, et al (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27: 2609–2615

    PubMed  CAS  Google Scholar 

  58. Ely EW, Margolin R, Francis J, May L, et al (1999) Delirium in the ICU: measurement and outcomes. Am J Respir Crit Care Med 161:A506 (abst)

    Google Scholar 

  59. Ely EW, Inouye SK, Bernard GR, et al (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAMICU). JAMA 286:2703–2710

    Article  PubMed  CAS  Google Scholar 

  60. Thomason JWW, Truman B, Ely EW, et al (2003) The impact of delirium in the ICU on outcomes of mechanical ventilation. Am J Respir Crit Care Med 167:A970 (abst)

    Google Scholar 

  61. Ely EW, Stephens R, Jackson JC, et al (2003) Current opinions regarding delirium in the ICU: A survey of 915 healthcare professionals. Crit Care Med (in press)

    Google Scholar 

  62. Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Mancebo J (1998) Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial of patients weaning from mechanical ventilation. Am J Respir Crit Care Med 158:1855–1862

    PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Thomason, J.W.W., Ely, E.W. (2005). Liberating Patients from Mechanical Ventilation: What Have We Learned About Protocolizing Care?. In: Slutsky, A.S., Brochard, L. (eds) Mechanical Ventilation. Update in Intensive Care Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-26791-3_10

Download citation

  • DOI: https://doi.org/10.1007/3-540-26791-3_10

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-20267-7

  • Online ISBN: 978-3-540-26791-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics