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The subtleties of the individual causes of respiratory failure, as I alluded to, are important to know, because the timing of that weaning is going to be different. Peter Bagley, in a paper published many years ago, showed that. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Skip to main content. Research Article Conference Proceedings. Alexander C White.
Abstract This paper reviews management strategies for patients undergoing prolonged mechanical ventilation PMV. Introduction Prolonged mechanical ventilation PMV provides ventilatory support to patients with either isolated failure of the respiratory system or respiratory failure occurring as a component of chronic critical illness. Weaning or Discontinuing PMV A recent consensus statement proposed categorizing patients into 3 groups, based on the duration of the weaning process, with patients who require PMV falling into group 3.
Identifying and Correcting Barriers to Weaning The major causes of failure to wean from PMV are linked to age, barriers to weaning mainly cardiorespiratory disease , and comorbid conditions that further complicate barriers to weaning and nutrition.
Special Situations There have been important advances in the care of certain patient populations with pulmonary disease over the past 2 decades. View this table: View inline View popup Download powerpoint. Table 1. Summary Strategies to effectively manage patients who require long term MV include systematically addressing barriers to weaning, ensuring appropriate weaning trials, optimizing the tracheostomy tube, and setting a realistic time frame for weaning attempts.
Discussion MacIntyre: In the long-term ventilated patient, what's the difference for someone with a tracheostomy with a pressure support of 10 cm H 2 O versus NIV via face mask? White: I think it probably doesn't matter whether you're getting NIV via face mask or nasal pillows or pressure support through a tracheostomy for a period of time in the LTAC, but when you're trying to get the patient home and to figure out what their care needs will be, its easier if you can eliminate suctioning and tracheostomy changes and all the equipment that goes along with a tracheostomy.
MacIntyre: In the acute care setting there's this huge drive to do SBTs in recovering patients, to understand when somebody is ready to come off the ventilator. Hess: To follow up on that, how much of liberating the patient from the ventilator is related to the weaning strategy and how much is related to fixing the underlying disease processes?
White: Yes, I read your editorial 1 on that and I think you're absolutely right.
Carson: Are we sometimes harming patients by putting them through the rigors of weaning, when what they should be doing is recovering? White: Probably. MacIntyre: I'm not sure how that applies in this population. Nelson: Is there a point in the weaning process when we can conclude that a patient with chronic critical illness is not going to wean from the ventilator, and come to terms with that conclusion?
White: There are, and you always have to be aware of them. King: You mentioned speaking valves. White: When you say abandoning the speaking valve, is that an in-line speaking valve with mechanical ventilation or over a tracheostomy? White: Using an in-line valve in somebody with a lot of secretions is very difficult. Hess: That's commonly what we do.
White: We rarely use the in-line speaking valves, and when we do, it's usually on the patient's demand. White: Well, the hypoxemic patient is more likely to be somebody with parenchymal disease, possibly. White: I think that how you remove the patient from the mechanical ventilator is going to be based on the strategies I outlined: removing the barriers and having a systematic way of evaluating the patient on a regular basis. The author has disclosed no conflicts of interest. References 1. Chronic critical illness. Weaning from mechanical ventilation. Eur Respir J ; 5 : - Chest ; 6 : - Age, invasive ventilatory support and outcomes in elderly patients admitted to intensive care units.
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The cuff on the endotracheal or tracheostomy tube provides airway occlusion. Proper cuff inflation ensures the patient receives the proper ventilator parameters, such as TV and oxygenation. Following hospital policy, inflate the cuff and measure for proper inflation pressure using the minimal leak technique or minimal occlusive volume.
These techniques help prevent tracheal irritation and damage caused by high cuff pressure; always practice them with an experienced nurse or respiratory therapist. Never add air to the cuff without using proper technique. Use a tonsil suction device if your patient needs more frequent suctioning.