ROLE OF PRESSURE SUPPORT VENTILATION (PSV) IN SUCCESSFUL EXTUBATION OF MECHANICAL VENTILATOR
Abstract
INTRODUCTION :
Ÿ Discontinuation of invasive mechanical ventilation
consists of 2 phases: weaning (abolishing the need for
ventilatory support) and extubation (removal of the
endotracheal tube [ETT] when it is no longer required).1
Extubation is a commonly performed procedure in ICUs.
Ÿ Weaning from MV accounts for up to 40% of time spent on
MV and an SBT constitutes the gold standard diagnostic
test to determine a patients' readiness for extubation
Ÿ Currently used SBT modalities include methods that
provide ventilatory support, such as pressure support
ventilation (5-8 cm H2O with or without PEEP), CPAP or
automatic tube compensation; and methods without any
ventilatory support, such as T-piece
Ÿ Decades of research have been dedicated to finding the
optimal protocolized SBT modality that best simulates
physiologic conditions post-extubation, in order to infer a
patients' readiness to liberate from MV
Ÿ Recent meta-analyses and guidance have been
inconclusive or contradicting
Ÿ Studies have shown that different SBT modalities and
duration demonstrate no significant difference regarding
success rate of extubation (PSV vs. T-piece for 2h, 30-
minute vs. 2h PSV or 30-minute vs. 2h T-piece). The optimal
SBT modality and duration to ascertain a patients'
readiness to be extubated remains unknown
Full Text:
PDFReferences
Ely EW. The utility of weaning protocols to expedite liberation from mechanical ventilation. Respir Care Clin N Am. 2000;6:303-319.
Smyrnios NA, Connolly A, Wilson MM, Curley FJ, French CT, Heard SO et al. Effects of a multifaceted, multidisciplinary, hospital-wide quality improvement program on weaning from mechanical ventilation. Crit Care Med. 2002;30:1224-1230.
Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical
ventilation. N Engl J Med. 1991;324:1445-1450.
Chatila W, Jacob B, Guaglionone D, Manthous CA. The unassisted respiratory rate-tidal volume ratio accurately predicts
weaning outcome. Am J Med. 1996;101:61-67.
EstebanA,FrutosF,TobinMJ,Alı ́aI,SolsonaJF,Valverdu ́ Ietal.Acomparisonoffourmethodsofweaningpatientsfrom
mechanical ventilation. N Engl J Med. 1995;332:345-350.
Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N et al. Comparison of three methods of gradual withdrawal
from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med. 1994;150:896-903.
EstebanA,Alı ́aI,GordoF,Ferna ́ndezR,SolsonaJF,Vallverdu ́ Ietal.Extubationoutcomeafterspontaneousbreathing
trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med. 1997;156:459-465.
EstebanA,Alı ́aI,TobinMJ,GilA,GordoF,Vallverdu ́Ietal.Effectofspontaneousbreathingtrialdurationonoutcomeof
attempts to discontinue mechanical ventilation. Am J Respir Crit Care Med. 1999;159:512-518.
Scha ̈dlerD,EngelC,ElkeG,PulletzS,HaakeN,FrerichsIetal.Automaticcontrolofpressuresupportforventilator
weaning in surgical intensive care patients. Am J Respir Crit Care Med. 2012;185:637-644.
Rose L, Schultz MJ, Cardwell CR, Jouvet P, McAuley DF, Blackwood B. Automated versus non-automated weaning for
reducing the duration of mechanical ventilation for critically ill adults and children. Cochrane Database Syst Rev.
;6:CD009235.
Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M et al. Noninvasive mechanical ventilation in the weaning of
patients with respiratory failure due to chronic obstructive pulmonary disease: a randomized, controlled trial. Ann Intern
Med. 1998;128:721-728.
Girault C, Paudenthun I, Chevran V, Tamion F, Leroy J, Bonmarchand G. Noninvasive ventilation as a systematic
extubation and weaning technique in acute on chronic respiratory failure. Am J Respir Crit Care Med. 1999;160:86-92.
Burns KE, Meade MO, Adhikari NKJ. Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults
with respiratory failure. Cochrane Database Syst Rev. 2013;12:CD004127.
Grasso S, Leone A, De Michele M, Anaclerio R, Cafarelli A, Ancona G et al. Use of N-terminal pro-brain natriuretic peptide
to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary
disease. Crit Care Med. 2007;35:96-100.
Lamia B, Maizel J, Ochagavia A, Chemla D, Osman D, Richard C et al. Echocardiographic diagnosis of pulmonary artery
occlusion pressure elevation during weaning from mechanical ventilation. Crit Care Med. 2009;37:1696-1670.
OSA in obese patients S.Patil CHEST volume 155, Issue 6 Page A383
Refbacks
- There are currently no refbacks.