- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Part 4.1 Physiology
- Part 4.2 Respiratory monitoring
- Part 4.3 Upper airway obstruction
- Part 4.4 Airway access
- Part 4.5 Acute respiratory failure
- Part 4.6 Ventilatory support
- Part 4.7 Weaning ventilatory support
- Chapter 102 Assessment and technique of weaning
- Chapter 103 Weaning failure in critical illness
- Part 4.8 Extracorporeal support
- Part 4.9 Aspiration and inhalation
- Part 4.10 Acute respiratory distress syndrome
- Part 4.11 Airflow limitation
- Part 4.12 Respiratory acidosis and alkalosis
- Part 4.13 Pneumonia
- Part 4.14 Atelectasis and sputum retention
- Part 4.15 Pleural cavity problems
- Part 4.16 Haemoptysis
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 469) Weaning ventilatory support
Several studies suggest that most patients weaned successfully could have tolerated the weaning attempts had they been initiated a day or so earlier. Such data emphasize the need for the early use of screening tests. A screening test should have a high sensitivity. The ratio of respiratory frequency to tidal volume has been evaluated in more than 25 studies and its average sensitivity is 0.89. Weaning involves undertaking three diagnostic tests in sequence, measuring predictors, a weaning trial, and a trial of extubation. Of the techniques used for a weaning trial, intermittent mandatory ventilation has been repeatedly shown to be inferior to the use of T-tube trials or pressure support. Six randomized trials have evaluated the usefulness of protocols in the management of weaning. Three revealed no benefit—two had major methodological problems, leaving only one supporting the use of protocols.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Part 4.1 Physiology
- Part 4.2 Respiratory monitoring
- Part 4.3 Upper airway obstruction
- Part 4.4 Airway access
- Part 4.5 Acute respiratory failure
- Part 4.6 Ventilatory support
- Part 4.7 Weaning ventilatory support
- Chapter 102 Assessment and technique of weaning
- Chapter 103 Weaning failure in critical illness
- Part 4.8 Extracorporeal support
- Part 4.9 Aspiration and inhalation
- Part 4.10 Acute respiratory distress syndrome
- Part 4.11 Airflow limitation
- Part 4.12 Respiratory acidosis and alkalosis
- Part 4.13 Pneumonia
- Part 4.14 Atelectasis and sputum retention
- Part 4.15 Pleural cavity problems
- Part 4.16 Haemoptysis
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care