Liberation from Mechanical Ventilation: Established and New Insights

Karen E.A. Burns; Arnav Agarwal; Karen J. Bosma; Dipayan Chaudhuri; Timothy D. Girard

doi:10.1055/s-0042-1747929

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2022; 43(03): 461-470
DOI: 10.1055/s-0042-1747929

Review Article

Liberation from Mechanical Ventilation: Established and New Insights

Karen E.A. Burns

¹Interdepartmental Division of Critical Care Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

²Departments of Critical Care and Medicine, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada

³Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

⁴Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada

,

Arnav Agarwal

³Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

⁵Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

,

Karen J. Bosma

⁶Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, and London Health Sciences Centre, London, Ontario, Canada

,

Dipayan Chaudhuri

³Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

⁷Departments of Critical Care Medicine and Medicine, McMaster University, Hamilton, Ontario, Canada

,

Timothy D. Girard

⁸The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

› Author Affiliations

Abstract

A substantial proportion of critically ill patients require ventilator support with the majority requiring invasive mechanical ventilation. Timely and safe liberation from invasive mechanical ventilation is a critical aspect of patient care in the intensive care unit (ICU) and is a top research priority for patients and clinicians. In this article, we discuss how to (1) identify candidates for liberation from mechanical ventilation, (2) conduct spontaneous breathing trials (SBTs), and (3) optimize patients for liberation from mechanical ventilation. We also discuss the roles for (4) extubation to noninvasive ventilation and (5) newer modes of mechanical ventilation during liberation from mechanical ventilation. We conclude that, though substantial progress has been made in identifying patients who are likely to be liberated (e.g., through the use of SBTs) and management strategies that speed liberation from the ventilator (e.g., protocolized SBTs, lighter sedation, and early mobilization), many important questions regarding liberation from mechanical ventilation in clinical practice remain unanswered.

Keywords

acute respiratory failure - mechanical ventilation - ventilator support

Full Text

References

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