Ventilatory Methods used to Wean Patients from Mechanical Ventilation

  • J. Mancebo
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 1995)


Intubation and mechanical ventilation are routine and live-saving procedures performed in the intensive care units (ICU). However, selecting what is the most appropriate time for extubation, probably is one of the most difficult decisions physicians must make. In our experience, around 70–75% of the patients who have been intubated, usually can be extubated without major clinical problems after a brief period of clinical observation during which the patient breathes spontaneously through a T-piece with supplemental oxygen as required [1]. The rate of extubation failures, i.e. the percentage of patients who must be re-intubated, is around 10%. There are, however, important differences depending on the patients’ disease process. In fact, patients who have a chronic obstructive pulmonary disease (COPD) and who meet usual extubation criteria (adequate clinical tolerance during unsupported breathing through a T-piece during 60–120 min), rarely require re-intubation. On the contrary, patients who needed intubation and mechanical ventilation due to a neurologic disease have a high rate of extubation failures (about 30%) despite meeting usual extubation criteria; one of the reasons is probably due to the fact that these patients do not have adequate expulsive forces for the clearance of secretions.


Continuous Positive Airway Pressure Chronic Obstructive Pulmonary Disease Patient Pressure Support Pressure Support Ventilation Inspiratory Effort 
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  1. 1.
    Benito S, Vallverdú I, Mancebo J (1991) Which patients need a weaning technique? In: Marini JJ, Roussos C (eds) Ventilatory failure. Update in intensive care and emergency medicine, Vol. 15. Springer-Verlag Berlin, pp 419–429Google Scholar
  2. 2.
    Tobin MJ (1990) Weaning from mechanical ventilation. Current Pulmonology 11: 47–105Google Scholar
  3. 3.
    Marini JJ (1986) The physiologic determinants of ventilator dependence. Respir Care 86: 271–283Google Scholar
  4. 4.
    Tobin MJ, Perez W, Guenther SM, et al (1986) The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dis 134: 1111–1118PubMedGoogle Scholar
  5. 5.
    Cohen CA, Zagelbaum C, Gross D, Roussos C, Macklem PT (1982) Clinical manifestations of inspiratory muscle fatigue. Am J Med 73: 308–316PubMedCrossRefGoogle Scholar
  6. 6.
    Brochard L, Rauss A, Benito S, et al (1995) Comparison of three methods of gradual withdrawing from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med (In press)Google Scholar
  7. 7.
    Brochard L, Harf A, Lorino H, Lemaire F (1989) Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am Rev Respir Dis 139: 513–521PubMedCrossRefGoogle Scholar
  8. 8.
    Appendini L, Patessio A, Zanaboni S, et al (1994) Physiological effects of positive end- expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 149: 1069–1076PubMedGoogle Scholar
  9. 9.
    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. Anesthesiology 75: 739–745PubMedCrossRefGoogle Scholar
  10. 10.
    Fiastro JF, Habib MP, Quan SF (1988) Pressure support compensation for inspiratory work due to endotracheal tubes and demand continuous positive airway pressure. Chest 93: 499–505PubMedCrossRefGoogle Scholar
  11. 11.
    Hubmayr RD (1994) Setting the ventilator. In: Tobin MJ (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York, pp 191–206Google Scholar
  12. 12.
    Sassoon CSH (1994) Intermittent mandatory ventilation. In: Tobin MJ (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York, pp 221–237Google Scholar
  13. 13.
    Marini JJ, Smith TC, Lamb VJ (1988) External work output and force generation during synchronized intermittent mechanical ventilation: Effect of machine assistance on breathing effort. Am Rev Respir Dis 138: 1169–1179PubMedGoogle Scholar
  14. 14.
    Quan SF, Falltrick RT, Schlobohm RM (1981) Extubation from ambient or expiratory positive airway pressure in adults. Anesthesiology 55: 53–56PubMedCrossRefGoogle Scholar
  15. 15.
    Katz JA, Marks JD (1985) Inspiratory work with and without continuous positive airway pressure in patients with acute respiratory failure. Anesthesiology 63: 598–607PubMedCrossRefGoogle Scholar
  16. 16.
    Petrof BJ, Legaré M, Goldberg P, Milic-Emili J, Gottfried SB (1990) Continuous positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 141: 281–289PubMedGoogle Scholar
  17. 17.
    Gibney RTN, Wilson RS, Pontoppidan H (1982) Comparison of work of breathing on high gas flow and demand valve continuous positive airway pressure systems. Chest 82: 692–695PubMedCrossRefGoogle Scholar
  18. 18.
    Viale JP, Annat G, Bertran O, Godard J, Motin J (1985) Additional inspiratory work in intubated patients breathing with continuous positive airway pressure systems. Anesthesiology 63: 536–539PubMedCrossRefGoogle Scholar
  19. 19.
    Samodelov LF, Falke KJ (1988) Total inspiratory work with modern demand valve devices compared to continuous flow CPAP. Intensive Care Med 14: 632–639PubMedCrossRefGoogle Scholar
  20. 20.
    Beydon L, Chassé M, Harf A, Lemaire F (1988) Inspiratory work of breathing during spontaneous ventilation using demand valves and continuous flow systems. Am Rev Respir Dis 138: 300–304PubMedGoogle Scholar
  21. 21.
    Banner MJ, Downs JB, Kirby RR, Smith RA, Boysen PG, Lampotang S (1988) Effects of expiratory flow resistance on inspiratory work of breathing. Chest 93: 795–799PubMedCrossRefGoogle Scholar
  22. 22.
    Marini JJ, Culver BH, Kirk W (1985) Flow resistance of exhalation valves and positive end-expiratory pressure devices used in mechanical ventilation. Am Rev Respir Dis 131: 850–854PubMedGoogle Scholar
  23. 23.
    Sassoon CSH, Giron AE, Ely EA, Light RW (1989) Inspiratory work of breathing on flow-by and demand-flow continuous positive airway pressure. Crit Care Med 17: 1108–1114PubMedCrossRefGoogle Scholar
  24. 24.
    Sassoon CSH, Lodia R, Rheeman CH, Kuei JH, Light RW, Mahutte CK (1992) Inspiratory muscle work of breathing during flow-by, demand-flow, and continuous-flow systems in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 145: 1219–1222PubMedCrossRefGoogle Scholar
  25. 25.
    Ranieri VM, Giuliani R, Gottfried SB, Fiore T (1992) Inspiratory muscle effort during SIMV: The effects of flow-by and pressure control. Am Rev Respir Dis 145: A519 (Abstr)Google Scholar
  26. 26.
    Polese G, Massara A, Brandolese R, Poggi R, Rossi A (1992) Flow-by system reduces the inspiratory effort during weaning from mechanical ventilation. Am Rev Respir Dis 145: A519 (Abstr)Google Scholar
  27. 27.
    Mancebo J, Vallverdú I, Bak E, et al (1993) Effects on the work of breathing (WOB) of different CPAP systems during weaning from mechanical ventilation. Am Rev Respir Dis 147: A876 (Abstr)Google Scholar
  28. 28.
    Ranieri VM, Giuliani R, Mascia L, Recchia F, Fiore T (1993) Effects of CPAP on inspiratory muscle effort in COPD patients: Flow-by vs. demand flow system. Am Rev Respir Dis 147: A878 (Abstr)CrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1995

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  • J. Mancebo

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