Tuesday, December 30, 2008

Top 10 issues in hospital medicine for 2008, issue 6: weaning from ventilators is obsolete

---(with only a few exceptions). Despite this fact the term “weaning” remains popular in critical care. The new thinking is that most patients should not be weaned. Rather, on any given day they are either ready for extubation or they are not. The job of the clinician is to do a daily assessment for readiness.

While this fact has been known for over a decade it made my 2008 top10 list because of a pivotal study this year in which the assessment was validated as an integrated protocol combining the daily sedation interruption with the spontaneous breathing trial, resulting in a striking mortality benefit.

1 comment:

james gaulte said...

It is good to hear that somethings we used to do may have been ok after all.That approach was exactly what my partners and I used to "get patients off" ventilators over 25 years ago and what I was taught to do in training. We would see how they did off the machine and if they "passed the audition" they were no longer on the ventilator.