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Ask the Expert on Weaning of Invasive Ventilated Patients

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Ask the Expert on Weaning of Invasive Ventilated Patients
In the weaning of invasive ventilated patients, the transition to noninvasive ventilation is difficult to manage. Are there evidence-based guidelines that cover switching from endotracheal intubation to another interface?

Klaus Ederle, MD

Any physician, nurse, or respiratory care practitioner involved in weaning patients from mechanical ventilation should read the report by SK Epstein. The bibliography in this review, which was presented at the Respiratory Care Journal Conference in Cancun, Mexico, in October 2001, contains 124 references and is the most up-to-date reference of its kind on this topic.

Several uncontrolled studies suggest that noninvasive positive pressure ventilation (NPPV) could be used to hasten ventilator weanings, with no different extubation/weaning criteria than are currently used for T-piece, continuous positive airway pressure, pressure support ventilation (PSV), synchronized intermittent mandatory ventilation (SIMV), and SIMV+PSV attempts.

Regarding the use of NPPV as a weaning adjunct, the questioner is referred to articles by Kilger, Restrick, and Udwadia and their colleagues for further information.

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