PURPOSE OF REVIEW: The decision to extubate is a crucial moment for intubated patients. In most cases, the transition to spontaneous breathing is uneventful, but in some patients, it implies a more challenging decision. Both extubation delay and especially the need for reintubation are associated with poor outcomes. We aim to review the recent literature on weaning and to clarify the role of certain interventions intending to help in this process. RECENT FINDINGS: Cardiac dysfunction is probably one of the most common causes of weaning failure. Several studies have evaluated the ability of B-natriuretic peptides and echocardiographic tools to predict weaning outcome due to cardiac origin, attempting to prevent its failure. Noninvasive ventilation may have a potential benefit in preventing respiratory failure after extubation of hypercapnic patients, although more studies are needed to define a target population. SUMMARY: Current research is focusing on preventing extubation failure, especially in the most challenging cases. The use of weaning protocols - written or computerized - attempts to early identify patients who are able to breathe spontaneously and to hasten extubation, resulting in better outcomes. Nevertheless, individualized care is needed in the most vulnerable patients, trying to prompt weaning without exposing patients to unnecessary risks.
PURPOSE OF REVIEW: The decision to extubate is a crucial moment for intubated patients. In most cases, the transition to spontaneous breathing is uneventful, but in some patients, it implies a more challenging decision. Both extubation delay and especially the need for reintubation are associated with poor outcomes. We aim to review the recent literature on weaning and to clarify the role of certain interventions intending to help in this process. RECENT FINDINGS:Cardiac dysfunction is probably one of the most common causes of weaning failure. Several studies have evaluated the ability of B-natriuretic peptides and echocardiographic tools to predict weaning outcome due to cardiac origin, attempting to prevent its failure. Noninvasive ventilation may have a potential benefit in preventing respiratory failure after extubation of hypercapnic patients, although more studies are needed to define a target population. SUMMARY: Current research is focusing on preventing extubation failure, especially in the most challenging cases. The use of weaning protocols - written or computerized - attempts to early identify patients who are able to breathe spontaneously and to hasten extubation, resulting in better outcomes. Nevertheless, individualized care is needed in the most vulnerable patients, trying to prompt weaning without exposing patients to unnecessary risks.
Authors: Carles Subirà; Gonzalo Hernández; Antònia Vázquez; Raquel Rodríguez-García; Alejandro González-Castro; Carolina García; Olga Rubio; Lara Ventura; Alexandra López; Maria-Carmen de la Torre; Elena Keough; Vanesa Arauzo; Cecilia Hermosa; Carmen Sánchez; Ana Tizón; Eva Tenza; César Laborda; Sara Cabañes; Victoria Lacueva; Maria Del Mar Fernández; Anna Arnau; Rafael Fernández Journal: JAMA Date: 2019-06-11 Impact factor: 56.272
Authors: Andrew J E Seely; Bram Rochwerg; Shannon M Fernando; Alexandre Tran; Behnam Sadeghirad; Karen E A Burns; Eddy Fan; Daniel Brodie; Laveena Munshi; Ewan C Goligher; Deborah J Cook; Robert A Fowler; Margaret S Herridge; Pierre Cardinal; Samir Jaber; Morten Hylander Møller; Arnaud W Thille; Niall D Ferguson; Arthur S Slutsky; Laurent J Brochard Journal: Intensive Care Med Date: 2021-11-25 Impact factor: 17.440
Authors: Gavin D Perkins; Dipesh Mistry; Simon Gates; Fang Gao; Catherine Snelson; Nicholas Hart; Luigi Camporota; James Varley; Coralie Carle; Elankumaran Paramasivam; Beverley Hoddell; Daniel F McAuley; Timothy S Walsh; Bronagh Blackwood; Louise Rose; Sarah E Lamb; Stavros Petrou; Duncan Young; Ranjit Lall Journal: JAMA Date: 2018-11-13 Impact factor: 56.272