EARLY WEANING FROM INVASIVE PRESSURE VENTILATION AMONG CRITICALLY ILL PATIENTS

Melba Sheila D’Souza, Porkodi Arjunan

Abstract


Purpose. To review the studies comparing outcomes with early weaning from the IPV among critically ill patients. Results. 11 of the studies were randomized controlled trials, 8 were nonrandomized controlled trials and 7 were cohort studies. 16 of these studies concluded that early weaning decreases the duration of IPV, length of stay, morbidity, and mortality in the intensive care units (p<0.05). 10 of the studies showed significant differences using sedation vacation, spontaneous breathing trials, spontaneous awakening trials, and mobilization while on IPV. Conclusion. Best practices in early weaning include a sedation vacation, spontaneous breathing trials, spontaneous awakening trials, mobilization and respiratory management. 

Keywords


Invasive pressure ventilation, early weaning, nurses, intensive care unit, critically ill patients, clinical practice

Full Text:

PDF

References


American Thoracic Society, & Infectious Diseases Society of America. (2005). Guidelines for the management of adults with Hospital-acquired, Ventilator-associated, and healthcare-associated pneumonia. American journal of respiratory and critical care medicine, 171(4), 388.

American Thoracic Society. International consensus conferences in intensive care medicine: noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 2001; 163:283–291

Arias-Rivera, S., del Mar Sánchez-Sánchez, M., Santos-Díaz, R., Gallardo-Murillo, J., Sánchez-Izquierdo, R., Frutos-Vivar, F., ... & Esteban, A. (2008). Effect of a nursing-implemented sedation protocol on weaning outcome. Critical care medicine, 36(7), 2054-2060.

Balas MC, Vasilevskis EE, Olsen KM, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014 May;42(5):1024-36. PMID: 24394627.

Bosma, K. J., Read, B. A., Nikoo, B., Mohammad, J., Jones, P. M., Priestap, F. A., & Lewis, J. F. (2016). A pilot randomized trial comparing weaning from mechanical ventilation on pressure support versus proportional assist ventilation. Critical care medicine, 44(6), 1098-1108.

Dries, D. J., McGonigal, M. D., Malian, M. S., Bor, B. J., & Sullivan, C. (2004). Protocol-driven ventilator weaning reduces the use of mechanical ventilation, the rate of early reintubation, and ventilator-associated pneumonia. Journal of Trauma and Acute Care Surgery, 56(5), 943-952.

Fan L, Su Y, Elmadhoun OA, et al. Protocol-directed weaning from mechanical ventilation in neurological patients: A randomized controlled trial and subgroup analyses based on consciousness. Neurol Res. 2015 Nov;37(11):1006-14. PMID: 26311500.

Frutos-Vivar, F., & Esteban, A. (2013). Weaning from mechanical ventilation: Why are we still looking for alternative methods?. Medicine Intensive (English Edition), 37(9), 605-617.

Fuller, B. M., Ferguson, I. T., Mohr, N. M., Drewry, A. M., Palmer, C., Wessman, B. T., ... & Kolomiets, A. A. (2017). A quasi-experimental, before-after trial examining the impact of an emergency department mechanical ventilator protocol on clinical outcomes and lung-protective ventilation in acute respiratory distress syndrome. Critical care medicine, 45(4), 645.

Kolomiets, A. A. (2017). A quasi-experimental, before-after trial examining the impact of an emergency department mechanical ventilator protocol on clinical outcomes and lung-protective ventilation in acute respiratory distress syndrome. Critical care medicine, 45(4), 645-652.

Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. Lancet 2008; 371(9607):126–34.

Haas, C. F., & Bauser, K. A. (2012). Advanced ventilator modes and techniques. Critical care nursing quarterly, 35(1), 27-38.

Iregui, M., Ward, S., Clinikscale, D., Clayton, D., & Kollef, M. H. (2002). Use of a handheld computer by respiratory care practitioners to improve the efficiency of weaning patients from mechanical ventilation. Critical care medicine, 30(9), 2038-2043.

Klompas M, Anderson D, Trick W, et al. The preventability of ventilator-associated events. The CDC prevention epicenters wake up and breathe collaborative. Am J Respir Crit Care Med. 2015 Feb;191(3):292-301. PMID: 25369558.

Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Aug;35(8):915-36. PMID: 25026607.

Kress J, Pohlman A, O'Connor M, et al. Daily interruption of sedative infusion in critically ill undergoing mechanical ventilation. N Engl J Med. 2000 May;342(20):1471-7. PMID: 10816184.

MacIntyre, N. R. (2012). Evidence-based assessments in the ventilator discontinuation process. Respiratory care, 57(10), 1611-1618.

Marelich GP, Murin S, Battistella F, et al. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: Effect on weaning time and incidence of ventilator-associated pneumonia. Chest. 2000 Aug;118(2):459-67. PMID: 10936141.

Marelich GP, Murin S, Battistella F, et al. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. Chest 2000; 118:459–467

Mcconville, J. F., & Kress, J. P. (2013). Weaning patients from the ventilator. The New England journal of medicine, 368(11), 1068.

Mehta S, Burry L, Cook D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: A randomized controlled trial. JAMA. 2012 Nov;308(19):1985-92. PMID: 23180503.

Navalesi, P., Frigerio, P., Moretti, M. P., Sommariva, M., Vesconi, S., Baiardi, P., & Levati, A. (2008). The rate of reintubation in mechanically ventilated neurosurgical and neurologic patients: evaluation of a systematic approach to weaning and extubation. Critical care medicine, 36(11), 2986-2992.

Peñuelas, Ó., Thille, A. W., & Esteban, A. (2015). Discontinuation of ventilatory support: new solutions to old dilemmas. Current opinion in critical care, 21(1), 74-81.

Pu, L., Zhu, B., Jiang, L., Du, B., Zhu, X., Li, A., ... & Jia, J. (2015). Weaning critically ill patients from mechanical ventilation: a prospective cohort study. Journal of critical care, 30(4), 862-e7.

Quenot J, Ladoire S, Devoucoux F, et al. Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia. Crit Care Med. 2007 Sep;35(9):2031-6. PMID: 17855817.

Rose, L., Schultz, M. J., Cardwell, C. R., Jouvet, P., McAuley, D. F., & Blackwood, B. (2015). Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children: a Cochrane systematic review and meta-analysis. Critical Care, 19(1), 48.

Stollings JL, Foss JJ, Ely EW, et al. Pharmacist leadership in ICU quality improvement: Coordinating spontaneous awakening and breathing trials. Ann Pharmacother. 2015 Aug;49(8):883-91. PMID: 25907528.

Tanios M, de Wit M, Epstein S, et al. Perceived barriers to the use of sedation protocols and daily sedation interruption: A multidisciplinary survey. Journal of Critical Care. 2009 Mar;24(1):66-73. PMID: 19272541


Refbacks

  • There are currently no refbacks.




Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright © 2018 INTERNATIONAL EDUCATION AND RESEARCH JOURNAL