RT Book, Section
A1 Manthous, Constantine A.
A1 Schmidt, Gregory A.
A1 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Kress, John P.
A2 Douglas, Ivor S.
SR Print(0)
ID 1201804355
T1 Liberation from Mechanical Ventilation
T2 Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781264264353
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1201804355
RD 2023/12/10
AB KEY  POINTSPatients  are  candidates  for  liberation  from  mechanical  ventilation  (MV)  when  gas  exchange  or  circulatory  disturbances  that  precipitated  respiratory  failure  have  been  reversed  sufficiently  to  permit  them  to  breathe  without  the  ventilator.More  than  half  of  all  critically  ill  patients  can  be  successfully  liberated  from  MV  after  a  brief  trial  of  spontaneous  breathing  on  the  first  day  that  reversal  of  precipitating  factors  is  recognized.  Gradual  reduction  of  mechanical  support,  termed  weaning,  is  frequently  unnecessary  and  can  prolong  the  duration  of  MV.Once  a  patient  has  been  liberated  from  the  ventilator,  extubation  should  follow  if  mechanisms  of  airway  maintenance  (cough,  gag,  swallow)  are  sufficient  to  protect  the  airway  from  secretions.  Whether  to  extubate  is  a  decision,  which  follows  successful  liberation  from  the  ventilator.In  patients  who  fail  their  first  trial  of  spontaneous  breathing,  attention  should  turn  to  defining  and  treating  the  pathophysiologic  processes  underlying  failure.Liberation  from  MV  is  achieved  most  expeditiously  if  eligible  patients  are  given  a  trial  of  spontaneous  breathing  (T-Piece  or  pressure  support  ≤7  cm  H2O)  each  day.  Patients  remain  on  ventilators  unnecessarily  when  clinicians  do  not  put  this  simple  plan  in  place.Patients  who  have  had  most  correctable  factors  addressed  and  remain  marginal  with  regard  to  ventilatory  capacity  should,  in  most  circumstances,  undergo  a  trial  of  extubation  rather  than  remain  intubated  for  protracted  periods  of  time.  Noninvasive  positive-pressure  ventilation  or  high-flow  oxygen  may  be  useful  in  these  patients  to  transition  them  to  fully  spontaneous  breathing  following  extubation.