| Popis: |
For the past 30 years extensive research has focused on determining readiness for weaning from mechanical ventilation (liberation) and on the mode of ventilator support that best accelerates the process of progressive withdrawal for those who prove difficult to liberate (Brochard et al. 1994; Ely et al. 1996; Esteban et al. 1995, 1997; Kollef et al. 1997). Once a patient no longer requires ventilatory support, the clinician must address a separate and distinct question. Can the patient tolerate extubation or the removal of the translaryngeal endotracheal tube? Over the past decade, the process and outcome of extubation have received increasing attention. One limiting factor is that many investigators have combined liberation and extubation failure into a single entity. In contrast, recent work clearly indicates that these are distinct processes with discrete pathophysiological causes and unique outcomes. |
