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Previous Volume 335:1864-1869 December 19, 1996 Number 25 Next

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ABSTRACT

Background Prompt recognition of the reversal of respiratory failure may permit earlier discontinuation of mechanical ventilation, without harm to the patient.

Methods We conducted a randomized, controlled trial in 300 adult patients receiving mechanical ventilation in medical and coronary intensive care units. In the intervention group, patients underwent daily screening of respiratory function by physicians, respiratory therapists, and nurses to identify those possibly capable of breathing spontaneously; successful tests were followed by two-hour trials of spontaneous breathing in those who met the criteria. Physicians were notified when their patients successfully completed the trials of spontaneous breathing. The control subjects had daily screening but no other interventions. In both groups, all clinical decisions, including the decision to discontinue mechanical ventilation, were made by the attending physicians.

Results Although the 149 patients randomly assigned to the intervention group had more severe disease, they received mechanical ventilation for a median of 4.5 days, as compared with 6 days in the 151 patients in the control group (P = 0.003). The median interval between the time a patient met the screening criteria and the discontinuation of mechanical ventilation was one day in the intervention group and three days in the control group (P<0.001). Complications — removal of the breathing tube by the patient, reintubation, tracheostomy, and mechanical ventilation for more than 21 days — occurred in 20 percent of the intervention group and 41 percent of the control group (P = 0.001). The number of days of intensive care and hospital care was similar in the two groups. Total costs for the intensive care unit were lower in the intervention group (median, $15,740, vs. $20,890 in the controls; P = 0.03); hospital costs were lower, though not significantly so (median, $26,229 and $29,048, respectively; P = 0.3).

Conclusions Daily screening of the respiratory function of adults receiving mechanical ventilation, followed by trials of spontaneous breathing in appropriate patients and notification of their physicians when the trials were successful, can reduce the duration of mechanical ventilation and the cost of intensive care and is associated with fewer complications than usual care.

Source Information

From the Department of Internal Medicine, Section on Pulmonary and Critical Care Medicine, the Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, N.C. (E.W.E., D.P.D., H.L.B., A.C.S., P.T.K., R.W.B., D.L.B., E.F.H.); Lynchburg Pulmonary Associates, Lynchburg, Va. (A.M.B.); and the Mayo Clinic, Jacksonville, Fla. (M.M.J.).

Address reprint requests to Dr. Ely at the Section on Pulmonary and Critical Care, Department of Medicine, Bowman Gray School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157.

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• (2002). ATS/ERS Statement on Respiratory Muscle Testing. Am. J. Respir. Crit. Care Med. 166: 518-624 [Full Text]  
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• Inayet, N., Amoateng-Adjepong, Y., Upadya, A., Manthous, C. A. (2000). Risks for Developing Critical Illness With GI Hemorrhage. Chest 118: 473-478 [Abstract] [Full Text]  
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• Gottschalk, A., Hyzer, M. C., Geer, R. T. (2000). A Comparison of Human and Machine-based Predictions of Successful Weaning from Mechanical Ventilation. Med Decis Making 20: 160-169 [Abstract]  
• PURRO, A., APPENDINI, L., DE GAETANO, A., GUDJONSDOTTIR, M., DONNER, C. F., ROSSI, A. (2000). Physiologic Determinants of Ventilator Dependence in Long-term Mechanically Ventilated Patients. Am. J. Respir. Crit. Care Med. 161: 1115-1123 [Abstract] [Full Text]  
• Brook, A. D., Kollef, M. H. (1999). An Outcomes-Based Approach to Ventilatory Management: Review of Two Examples: Brook AD, Kollef MH An outcomes-based approach to ventilatory management review of two examples J Intensive Care Med 1999,14 262-274. J Intensive Care Med 14: 262-274  
• Wunderink, R. G. (1999). Prevention of Ventilator-Associated Pneumonia : Does One Size Fit All?. Chest 116: 1155-1156 [Full Text]  
• THIAGARAJAN, R. R., BRATTON, S. L., MARTIN, L. D., BROGAN, T. V., TAYLOR, D. (1999). Predictors of Successful Extubation in Children. Am. J. Respir. Crit. Care Med. 160: 1562-1566 [Abstract] [Full Text]  
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• GIRAULT, C., DAUDENTHUN, I., CHEVRON, V., TAMION, F., LEROY, J., BONMARCHAND, G. (1999). Noninvasive Ventilation as a Systematic Extubation and Weaning Technique in Acute-on-Chronic Respiratory Failure . A Prospective, Randomized Controlled Study. Am. J. Respir. Crit. Care Med. 160: 86-92 [Abstract] [Full Text]  
• Price, J. A., Rizk, N. W. (1999). Postoperative Ventilatory Management. Chest 115 : 130S-137S [Abstract] [Full Text]  
• Bach, J. R., Manthous, C. A., Schmidt, G. A., Hall, J. B. (1999). Liberation From Mechanical Ventilation : Now for the Rest of the Story. Chest 115: 1217-1217 [Full Text]  
• ELY, E. W., BENNETT, P. A., BOWTON, D. L., MURPHY, S. M., FLORANCE, A. M., HAPONIK, E. F. (1999). Large Scale Implementation of a Respiratory Therapist- driven Protocol for Ventilator Weaning. Am. J. Respir. Crit. Care Med. 159: 439-446 [Abstract] [Full Text]  
• ESTEBAN, A., ALÍA, I., TOBIN, M. J., GIL, A., GORDO, F., VALLVERDÚ, I., BLANCH, L., BONET, A., VÁZQUEZ, A., de PABLO, R., TORRES, A., de la CAL, M. A., MACÍAS, S. (1999). Effect of Spontaneous Breathing Trial Duration on Outcome of Attempts to Discontinue Mechanical Ventilation. Am. J. Respir. Crit. Care Med. 159: 512-518 [Abstract] [Full Text]  
• Mehta, S., Lapinsky, S. E., Antonelli, M., Conti, G. (1999). Noninvasive Positive-Pressure Ventilation. NEJM 340: 150-151 [Full Text]