ICU SAQs · Mechanical ventilation
Weaning and liberation from mechanical ventilation
A high-yield Second-Part question spanning the weaning screen, the spontaneous breathing trial, the relative merits of pressure-support, T-piece and SIMV, the rapid shallow breathing index, and the recognition of weaning-induced cardiac failure.
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Prompt
A 70-year-old man has been intubated and ventilated for five days after an emergency laparotomy for a perforated viscus. He is now resolving. Describe how you would assess his readiness to wean, conduct the process of liberation, and recognise and investigate weaning failure.
Question
A 70-year-old man has been intubated and ventilated for five days after an emergency laparotomy for a perforated viscus. He is now resolving. Describe how you would assess his readiness to wean, conduct the process of liberation, and recognise and investigate weaning failure.
References4ShowHide
- [1]Yang KL, Tobin MJ. A Prospective Study of Indexes Predicting the Outcome of Trials of Weaning from Mechanical Ventilation. New England Journal of Medicine, 1991.PMID 2023603
- [2]Brochard L, et al. Comparison of Three Methods of Gradual Withdrawal from Ventilatory Support during Weaning from Mechanical Ventilation. American Journal of Respiratory and Critical Care Medicine, 1994.PMID 7921460
- [3]Esteban A, Frutos F, Tobin MJ, et al. A Comparison of Four Methods of Weaning Patients from Mechanical Ventilation. New England Journal of Medicine, 1995.PMID 7823995
- [4]Bersten AD, Soni N (eds). Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.