| Popis: |
Although invasive mechanical ventilation has beneficial effects on acute respiratory failure pathophysiology, in most instances it principally provides support while the respiratory system recovers. Invasive mechanical ventilation is associated with significant time-dependent risks and complications including ventilator-associated pneumonia (VAP), sinusitis, airway injury, thromboembolism, and gastrointestinal bleeding. Therefore, once significant clinical improvement occurs, efforts shift to rapidly removing the patient from the ventilator; a process variably referred to as weaning, liberation, or discontinuation. Fortunately, 75% of patients satisfying weaning readiness criteria tolerate their initial spontaneous breathing trial (SBT), conducted with no or minimal ventilator assistance, indicating that mechanical support is no longer required. A minority are initially intolerant of spontaneous breathing and require a more gradual weaning process. Once spontaneous breathing or weaning is tolerated, the question of whether the endotracheal tube is still required is addressed to determine suitability for extubation. A large recent body of evidence provides the basis for offering concise recommendations on the best methods for weaning from mechanical ventilation (Table 1). |
