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Mechanical Ventilator Weaning Protocols Driven by Nonphysician Health-Care Professionals: Evidence-Based Clinical Practice Guidelines
Section snippets
Materials and Methods
We have described the methods of our reviews in the introduction to this supplement and in the article concerning alternative discontinuation assessment methods and weaning modes. Herein, we summarize these methods briefly, focusing on aspects specific to this topic.
Results
We identified four randomized controlled trials (RCTs) that compared protocol-based weaning to conventional weaning (Table 1).9101112 One very small trial10 (15 patients) compared computer-directed weaning to physician-directed weaning and found trends in favor of the computer-directed weaning in both nonextubation and reintubation rates (Table 2).
Three RCTs91112 compared weaning protocols that were largely implemented by RCPs and nurses to conventional physician-directed weaning. These trials
Discussion
To provide clinicians with the most useful information set for the design and implementation of weaning protocols, we have structured this section into seven key recommendations (Table 5). The results of the foregoing evidence-based review were incorporated into the first three recommendations. The last four recommendations were derived from emerging data about weaning from MV and extubation, the optimal delivery of sedation and analgesia in the ICU, and the need for an objective and graded
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What Are the Benefits of Different Ventilatory Techniques?
2022, Evidence-Based Practice of AnesthesiologyWeaning from mechanical ventilation in neurocritical care
2022, Revue NeurologiqueCitation Excerpt :A body of literature has identified factors that are associated with successful extubation: young age [7], low severity on ICU admission, short duration of MV prior to extubation [8], normocapnia [9], negative fluid balance immediately prior to extubation [10]. However, in a given patient, these factors do not allow prediction of whether weaning will be successful or not [11,12]. For this reason, a consensus conference held in 2006 has proposed a systematic approach based on step-by-step management of the weaning process [13].
This article is based on work performed by the McMaster University Evidence-based Practice Center, under contract to the Agency for Healthcare Research and Quality (Contract No. 290-97-0017), Rockville, MD.
This research was supported by National Institutes of Health grant No. AG01023-01A1 (EWE) and a Beeson Scholarship from the American Federation for Aging Research (EWE).