Weaning from mechanical ventilation

Article Abstract:

In an article in the May 23, 1991 issue of The New England Journal of Medicine, researchers report the development of new objective criteria to help decide whether a patient on artificial respiration may be successfully weaned from dependence upon the mechanical ventilator. The article illustrates both the difficulties in making such decisions and recent advances in the understanding of respiratory physiology. Generally, patients on respirators have neuromuscular weakness, severe lung disease, or catabolic illness. (A catabolic illness is one in which many of the body's components are breaking down, as is often the case in diseases such as cancer.) Mechanical ventilation may sometimes be necessary because the brain can not properly control breathing, but most commonly the respiratory system is not physically able to perform. Ventilator patients are weak and often malnourished. Unfortunately, when placed on a respirator, the already weak respiratory muscles begin to lose even more strength and the muscle structure itself will begin to deteriorate. For this reason, it is necessary to 'wean' the patient off the respirator. If the respirator is turned off, the patient may be able to breath at first, but then the metabolic demands of the breathing process may catch up. The respiratory muscles can not sustain the effort if it is too great. Questions of nutrition are also important; adequate nutrition is critical, but any excess of carbohydrates or fats may increase the production of carbon dioxide. More carbon dioxide means that the crippled respiratory system is made to work even harder to get rid of it. When the patient is weaned, attempts to reach normal levels of carbon dioxide may place too many demands on the respiratory system and result in an overload of work. While new criteria for successful weaning from the respirator, such as those published in the latest New England Journal, may be helpful, the procedure still requires careful management by physicians with a clear understanding of the physiology of respiration. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Physiological aspects, editorial, Ventilator weaning

---

Noninvasive ventilation

Article Abstract:

Ventilation through a nasal or face mask can support breathing and improve oxygenation in patients with a variety of medical conditions. Noninvasive methods are more comfortable, avoid complications of inserting a breathing tube, and retain the use of the throat for eating and speaking. Ventilation applies airway pressure during breathing to reduce respiratory effort, and sometimes is only required for several hours each day or during sleep. Those with respiratory failure, congestive heart failure, neuromuscular diseases and obstructive sleep apnea may benefit from this therapy.

Care and treatment, Respiratory tract diseases

---

Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously

Article Abstract:

Patients in intensive care units (ICUs) can be successfully weaned off mechanical ventilation to resume spontaneous breathing after daily respiratory monitoring. Researchers compared the cost and length of stay in 149 patients monitored daily to that of 151 patients in standard care. The ICU stay of the monitored group cost $15,740, while expenses in the control group totalled $20,890. The controls had complications related to artificial breathing at twice the rate of the monitored patients and the overall cost of hospitalization was slightly higher as well.

Economic aspects, Intensive care units, Patient monitoring, Physiologic monitoring

Similar abstracts:

• Abstracts: Pregnancy and its effect on the risk of developing rheumatoid arthritis. A reappraisal of the evidence that rheumatoid arthritis and several other idiopathic diseases are slow bacterial infections
• Abstracts: Health insurance values and implementation in the Netherlands and the Federal Republic of Germany: an alternative path to universal coverage
• Abstracts: A national health program: abyss at the end of the tunnel - the position of physicians who care. The Health Security Partnership: a federal-state universal insurance and cost-containment program
• Abstracts: Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. Advances in the prevention and treatment of Mycobacterium avium disease
• Abstracts: Membranous nephropathy related to hepatitis B virus in adults. Membranous nephropathy - still a treatment dilemma

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.