RT Book, Section
A1 Lee, Ilde Manuel
A1 Voigt, Louis P.
A2 Oropello, John M.
A2 Pastores, Stephen M.
A2 Kvetan, Vladimir
SR Print(0)
ID 1136418153
T1 Controversies: Ventilator Weaning—Which Strategy is Better? RT-RN Versus Physician Driven
T2 Critical Care
YR 1
FD 1
PB McGraw-Hill Education
PP New York, NY
SN 9780071820813
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1136418153
RD 2024/04/18
AB The  advent  of  invasive  mechanical  ventilation  (IMV)  has  been  one  of  the  greatest  achievements  in  the  field  of  respiratory  and  critical  care  medicine.  In  the  United  States  alone,  there  were  790,257  hospitalizations  involving  IMV  in  2005,  and  that  number  is  expected  to  steadily  increase,  outpacing  population  growth  by  2026.1,2  Although  advances  in  medical  technology  have  facilitated  the  management  of  patients  who  require  ventilatory  support,  mechanical  ventilation  remains  associated  with  risks  and  complications.3  Thus,  once  clinical  improvement  occurs,  significant  emphasis  is  placed  on  rapidly  weaning  the  patient  from  IMV.  Over  the  past  25  years,  numerous  trials  have  evaluated  the  most  effective  approach  to  liberate  patients  from  IMV,  including  the  use  of  protocol-based  weaning  (PBW).  Compared  to  physician-directed  weaning,  protocolized  strategies  driven  by  nurses  and/or  respiratory  therapists  (RTs)  have  gained  general  acceptance  in  many  intensive  care  units  (ICUs)  because  of  reduction  in  morbidity,  mortality,  and  health-care  costs  (Table  65–1).4,5,6