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The difficult to wean ABC approach

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2 papers 100 to 500 followers
By Jason Mann No BS pulmonary critical care fellow
Amal Jubran, Brydon J B Grant, Lisa A Duffner, Eileen G Collins, Dorothy M Lanuza, Leslie A Hoffman, Martin J Tobin
IMPORTANCE: Patients requiring prolonged mechanical ventilation (>21 days) are commonly weaned at long-term acute care hospitals (LTACHs). The most effective method of weaning such patients has not been investigated. OBJECTIVE: To compare weaning duration with pressure support vs unassisted breathing through a tracheostomy collar in patients transferred to an LTACH for weaning from prolonged ventilation. DESIGN, SETTING, AND PARTICIPANTS: Between 2000 and 2010, a randomized study was conducted in tracheotomized patients transferred to a single LTACH for weaning from prolonged ventilation...
February 20, 2013: JAMA: the Journal of the American Medical Association
Leo M Heunks, Johannes G van der Hoeven
About 20% to 30% of patients are difficult to wean from invasive mechanical ventilation. The pathophysiology of difficult weaning is complex. Accordingly, determining the reason for difficult weaning and subsequently developing a treatment strategy require a dedicated clinician with in-depth knowledge of the pathophysiology of weaning failure. This review presents a structural framework ('ABCDE') for the assessment and treatment of difficult-to-wean patients. Earlier recognition of the underlying causes may expedite weaning from mechanical ventilation...
2010: Critical Care: the Official Journal of the Critical Care Forum
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