Advances in mechanical ventilation

Article Abstract:

A review of the use of ventilators in patients with severe lung disease is presented. Topics include basic principles, coordinating ventilation to breathing, improving oxygenation, preventing lung injury, and weaning the patient from the ventilator.

Analysis, Usage, Ventilators, Ventilators (Medical equipment)

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A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation

Article Abstract:

Mechanical ventilation of the lungs has saved the lives of numerous patients. However, whenever a patient can not breathe adequately without support and is placed on a respirator, the question will arise concerning when he or she might be ready to start breathing on his or her own and be removed from the respirator. Clearly, it is undesirable to leave a patient on a respirator longer than is required, but removing a patient too soon can result in a great deal of unnecessary stress. In many cases, it is possible for an experienced physician to predict with fair success the chances of successful weaning from a respirator. However, it would be advantageous to have some objective criterion to predict the likelihood of successful weaning. Various indices of respiratory (breathing) performance, which have previously been proposed, have performed poorly in practice. Respiratory function is a complex process, and it seems likely that many different physiological factors contribute to the overall ability of a patient to be weaned from the respirator. Data obtained from 36 respirator patients were combined to devise respiratory indices that might more accurately reflect overall respiratory function. Once these indices were determined, they were evaluated on an additional 64 patient and used to distinguish between patients who could be successfully weaned from a mechanical ventilator and those who could not. The results showed that the most sensitive and specific determinant of who could and could not be successfully weaning was the ratio between the number of breaths per minute and the volume of air of each breath. As this number grew larger, either by more rapid breaths, smaller breath volumes (shallow breathing), or both, the patient was less likely to be successfully weaned. The converse was also true, if the patient did not have an abnormally high ratio, the chances for successful weaning from the mechanical respirator were good. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Ventilator weaning

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A comparison of four methods of weaning patients from mechanical ventilation

Article Abstract:

A trial of spontaneous breathing one or more times a day is more effective in weaning patients off a mechanical ventilator than intermittent mandatory ventilation or pressure-support ventilation. The two latter techniques are ways of weaning patients by allowing them to breathe in between ventilations or periodically adjusting ventilator settings. Of 546 patients on a ventilator, 372 were successfully taken off the ventilator after a two-hour trial of spontaneous breathing. One hundred-thirty who could not be weaned were allocated into one of four groups: once-daily spontaneous breathing, intermittent spontaneous breathing, intermittent mandatory ventilation and pressure-support ventilation. Patients in the once-daily or intermittent spontaneous breathing groups were weaned more quickly than those in the remaining groups. Spontaneous breathing trials are much simpler since they do not require adjusting ventilator settings.

Care and treatment, Respiratory insufficiency

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