Podcast
Questions and Answers
Which of the following criteria is NOT required for a formal assessment of discontinuation potential for patients receiving mechanical ventilation?
Which of the following criteria is NOT required for a formal assessment of discontinuation potential for patients receiving mechanical ventilation?
- Capability to initiate an inspiratory effort
- Requirement of high levels of ventilatory support (correct)
- Hemodynamic stability with absence of myocardial ischemia
- Adequate oxygenation and pH
What level of PaO2/FIO2 is considered adequate for patients undergoing a formal assessment of discontinuation potential from mechanical ventilation?
What level of PaO2/FIO2 is considered adequate for patients undergoing a formal assessment of discontinuation potential from mechanical ventilation?
- 200–250
- 100–150
- 150–200 (correct)
- 250–300
Why is it important to maintain an appropriate level of ventilatory support for patients with unresolving respiratory failure?
Why is it important to maintain an appropriate level of ventilatory support for patients with unresolving respiratory failure?
- To facilitate rapid weaning from mechanical ventilation
- To avoid myocardial ischemia
- To reduce the risk of respiratory muscle fatigue (correct)
- To prevent hypotension
When does the process of discontinuation of mechanical ventilation start, according to the text?
When does the process of discontinuation of mechanical ventilation start, according to the text?
What may low cuff leak values indicate in patients on mechanical ventilation?
What may low cuff leak values indicate in patients on mechanical ventilation?
What should be readily available for extubating patients with low cuff leak values?
What should be readily available for extubating patients with low cuff leak values?
What is difficult to extrapolate to more typical ICU patients regarding successful extubations in brain-injured comatose patients?
What is difficult to extrapolate to more typical ICU patients regarding successful extubations in brain-injured comatose patients?
What predicts successful extubation in neuromuscular- or spinal cord-injured patients?
What predicts successful extubation in neuromuscular- or spinal cord-injured patients?
What should be determined for patients who fail a spontaneous breathing test (SBT)?
What should be determined for patients who fail a spontaneous breathing test (SBT)?
What should a failed SBT prompt a search for in patients on mechanical ventilation?
What should a failed SBT prompt a search for in patients on mechanical ventilation?
What should patients who fail an SBT receive?
What should patients who fail an SBT receive?
What is the evidence supporting the waiting of 24 hours before attempting an SBT again in patients with respiratory failure based on?
What is the evidence supporting the waiting of 24 hours before attempting an SBT again in patients with respiratory failure based on?
What do twice-daily SBTs offer over a single SBT?
What do twice-daily SBTs offer over a single SBT?
What is problematic in the evaluation of evidence addressing mechanical ventilatory support strategies?
What is problematic in the evaluation of evidence addressing mechanical ventilatory support strategies?
Which criteria are used to assess patient tolerance during spontaneous breathing?
Which criteria are used to assess patient tolerance during spontaneous breathing?
Why are clinical assessments alone considered insufficient to make decisions on the discontinuation of support?
Why are clinical assessments alone considered insufficient to make decisions on the discontinuation of support?
What did the McMaster AHCPR report find regarding specific measurements as predictors of successful discontinuation?
What did the McMaster AHCPR report find regarding specific measurements as predictors of successful discontinuation?
What is used to determine discontinuation potential according to the text?
What is used to determine discontinuation potential according to the text?
What are the criteria for assessing patient tolerance during spontaneous breathing?
What are the criteria for assessing patient tolerance during spontaneous breathing?
Why is clinical impression considered inaccurate in determining successful discontinuation of ventilatory support?
Why is clinical impression considered inaccurate in determining successful discontinuation of ventilatory support?
What is used to determine successful discontinuation of ventilatory support?
What is used to determine successful discontinuation of ventilatory support?
What did the McMaster AHCPR report find regarding the likelihood ratios to predict successful discontinuation?
What did the McMaster AHCPR report find regarding the likelihood ratios to predict successful discontinuation?
When should formal discontinuation assessments for patients be done?
When should formal discontinuation assessments for patients be done?
Why are clinical assessments alone insufficient to make decisions on the discontinuation of support?
Why are clinical assessments alone insufficient to make decisions on the discontinuation of support?
What is the role of subjective comfort in assessing patient tolerance during spontaneous breathing?
What is the role of subjective comfort in assessing patient tolerance during spontaneous breathing?
Why are specific measurements and their threshold values important?
Why are specific measurements and their threshold values important?
What is the advantage of stable support between daily Spontaneous Breathing Trials (SBTs)?
What is the advantage of stable support between daily Spontaneous Breathing Trials (SBTs)?
What is the clinical focus after a failed SBT?
What is the clinical focus after a failed SBT?
What is the preferred characteristic of assisted modes of ventilation?
What is the preferred characteristic of assisted modes of ventilation?
What is the purpose of noninvasive positive-pressure ventilation (NPPV) in ventilator discontinuation?
What is the purpose of noninvasive positive-pressure ventilation (NPPV) in ventilator discontinuation?
What does the data suggest about the use of NPPV in post-extubation support?
What does the data suggest about the use of NPPV in post-extubation support?
What should be the focus of anesthesia/sedation strategies and ventilator management in postsurgical patients?
What should be the focus of anesthesia/sedation strategies and ventilator management in postsurgical patients?
What is the purpose of ventilator support modes developed to automatically wean patients?
What is the purpose of ventilator support modes developed to automatically wean patients?
What does the text say about the evidence supporting the claims for gradual reductions in ventilator support?
What does the text say about the evidence supporting the claims for gradual reductions in ventilator support?
What is the focus of clinical care after a failed SBT?
What is the focus of clinical care after a failed SBT?
What is the purpose of stable support between SBTs?
What is the purpose of stable support between SBTs?
What is the clinical focus after a failed SBT?
What is the clinical focus after a failed SBT?
What is the preferred characteristic of assisted modes of ventilation?
What is the preferred characteristic of assisted modes of ventilation?
Study Notes
Ventilator Weaning and Discontinuing Support
- Arguments for gradual reductions include muscle conditioning and easier transition to extubation or SBT
- Data supporting these claims are limited
- A stable level of support between SBTs reduces the risk of ventilatory muscle overload
- Daily SBTs with stable support between tests allow the most rapid discontinuation
- No evidence that gradual support reductions coupled with daily SBTs offer any advantages
- Other randomized trials compared gradual reduction strategies using different modes but not routine daily SBTs
- Clinical focus after a failed SBT should be on maintaining adequate muscle unloading, optimizing comfort, and avoiding complications
- Assisted modes of ventilation are generally preferable and allow patient muscle activity and some control over the ventilatory pattern
- Several ventilator support modes have been developed to automatically wean patients through feedback from ventilator-measured parameters
- Noninvasive positive-pressure ventilation has been used to facilitate the discontinuation of invasive ventilatory support
- Data suggests the need for reductions in the duration of mechanical ventilation, ICU stay, mortality, and the incidence of nosocomial pneumonia with post-extubation support provided by NPPV
- Anesthesia/sedation strategies and ventilator management aimed at early extubation should be used in postsurgical patients
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Description
Test your knowledge on ventilator weaning and discontinuing support with this quiz. Explore gradual reductions, stable support, daily SBTs, assisted ventilation modes, NPPV, and strategies for early extubation in postsurgical patients.
