Abstract
Unnecessarily prolonging or prematurely discontinuing mechanical ventilation may result in significant morbidity and even mortality. In order to optimize the timing of ventilation discontinuation, evidence-based guidelines suggest that patients undergo a daily screen (for measures of oxygenation, cough and secretions, adequate mental status, and hemodynamic stability) to assess weaning readiness [1]. For patients meeting the criteria, a spontaneous breathing trial is then performed in order to assess their ability to breathe unaided. The way the trial is tolerated, determined by both objective (respiratory and hemodynamic parameters) and subjective (evidence of increased work of breathing and distress) criteria, determines whether extubation is performed.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
MacIntyre NR, Cook DJ, Ely EW Jr, 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 Crit Care Med. Chest 120 (Suppl 6):375S–395S
Seymour CW, Halpern S, Christie JD, Gallop R, Fuchs BD (2008) Minute ventilation recovery time measured using a new simplified methodology predicts extubation outcome. J Intensive Care 23: 52–60
Chien J, Lin M, Huang YT, Chien Y, Yu C, Yang P (2008) Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial. Crit Care Med 36: 1421–26
Robertson E, Sona C, Schallom L, et al (2008) Improved extubation rates and earlier liberation from mechanical ventilation with implementation of a daily spontaneous-breathing trial protocol. J Am Coll Surg 206: 489–95
Frutos-Vivar F, Esteban A (2003) When to wean from a ventilator: an evidence-based strategy. Clev Clin J Med 70: 389–400
Koksal GM, Sayilgan C, Sen O, Oz H (2004) The effects of different weaning modes on the endocrine stress response. Crit Care 8: R31–34
Esteban A, Alia I, Gordo F, et al (1997) Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med 156: 459–465
Petrof BJ, Legare M, Goldberg P, Milic-Emili J, Gottfried SB (1990) Continuous positive airway pressure reduces the work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 141: 281–289
Brochard L, Rua F, Lorino H, Lemaire F, Harf A (1991) Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube. Anaesthesiology 75: 739–745
Fabry B, Guttman J, Eberhard L, Wolff G (1994) Automatic tube compensation of endotracheal tube resistance in spontaneously breathing patients. Tech Health Care 1: 281–291
Haberthur C, Elsasser S, Eberhard L, Stocker R, Guttmann J (2000) Total versus tube-related additional work of breathing in ventilator-dependent patients. Acta Anaesthesiol Scand 44: 749–757
Guttmann, J, Eberhard, L, Fabry, B, et al (1993) Continuous calculation of intratracheal pressure in tracheally intubated patients. Anaesthesiology 79: 503–513
Fabry, B, Haberthur, C, Zappe, D, et al (1997) Breathing pattern and additional work of breathing in spontaneously breathing patients with different ventilatory demands during inspiratory pressure support and automatic tube compensation. Intensive Care Med 23: 545–552
Guttmann J, Bernhard H, Mols G, et al (1997) Respiratory comfort of automatic tube compensation and inspiratory pressure support in conscious humans. Intensive Care Med 23: 1119–1124
Haberthur C, Fabry, Zappe D, et al (1998) Effects of mechanical unloading and mechanical loading on respiratory loop gain and periodic breathing in man. Respir Physiol 112: 23–36
Stocker R, Fabry B, Haberthur C (1997) New modes of ventilatory support in spontaneously breathing intubated patients. In: Vincent JL (ed) Yearbook of Intensive Care and Emergency Medicine. Springer, Heidelberg, 514–533
Elsasser S, Guttmann J, Stocker R, Mois G, Priebe HJ, Haberthur C (2003) Accuracy of automatic tube compensation in new-generation mechanical ventilators. Crit Care Med 31: 2619–2626
Haberthur C, Mols G, Elsasser S, Bingisser R, Stocker R, Guttmann J (2002) Extubation after breathing trials with automatic tube compensation, T-tube or pressure support ventilation. Acta Anaesthesiol Scand 46: 973–979
Ferreyra G, Weber-Cartens S, Aquadrone V, et al (2007) Comparison of automatic tube compensation (ATC) with pressure support ventilation (PSV) during spontaneous breathing trials. Intensive Care Med 33: s57 (abst)
Cohen J, Shapiro M, Grozovski E, Lev S, Fisher H, Singer P (2006) Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure. Crit Care Med 34: 682–686
Eskandar N, Apostolakos MJ (2007) Weaning from mechanical ventilation. Crit Care Clin 23: 263–274
Siner JM, Manthous CA (2007) Liberation from mechanical ventilation: what monitoring matters? Crit Care Clin 23: 613–638
Frutos-Vivar F, Ferguson ND, Esteban A, et al (2006) Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 130: 1664–1671
Ely W, Baker AM, Dunagan DP, et al (1996) Effect on the duration of mechanical ventilation of identifying patients capable of spontaneous ventilation. N Eng J Med 335: 1864–1869
Lee KH, Hui KP, Chan TB, et al (1994) Rapid shallow breathing (frequency to tidal volume ratio) did not predict extubation outcome. Chest 105: 540–543
Chatila, W, Jacob, B, Guanglione, D, et al (1996) The unassisted respiratory rate: tidal volume ratio accurately predicts weaning outcome. Am J Med 101: 61–67
Cohen JD, Shapiro M, Grozovski E, Singer P (2002) Automatic tube compensation-assisted respiratory rate to tidal volume ratio improves the prediction of weaning outcome. Chest 122: 980–984
Unoki T, Serita A, Grap MJ (2008) Automatic tube compensation during weaning from mechanical ventilation. Evidence and clinical implications. Crit Care Nurse 28: 34–42
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Cohen, J., Shapiro, M., Singer, P. (2009). Automatic Tube Compensation in the Weaning Process. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92278-2_32
Download citation
DOI: https://doi.org/10.1007/978-0-387-92278-2_32
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-92277-5
Online ISBN: 978-0-387-92278-2
eBook Packages: MedicineMedicine (R0)