Weaning older patients from long-term mechanical ventilation: a pilot study
As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation. To describe temporal changes in pulmonary and systemic variables in older adults receivi...
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Published in | American journal of critical care Vol. 11; no. 4; pp. 369 - 377 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
United States
American Association of Critical-Care Nurses
01.07.2002
American Association of Critical - Care Nurses |
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Abstract | As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation.
To describe temporal changes in pulmonary and systemic variables in older adults receiving long-term mechanical ventilation.
After 3 days of unsuccessful attempts at weaning from ventilatory support, 10 trauma and surgical patients more than 60 years old were monitored daily. Previously reported predictors of the duration of mechanical ventilation and weaning outcome were measured, including hemodynamic and gas exchange variables, oxygen cost of breathing, and the score on the Burns Weaning Assessment Program.
The 6 patients who could be weaned from ventilatory support were younger (median age, 71.5 years) than the 4 patients who could not be weaned (median age, 80 years). Patients who could be weaned were ready for weaning by day 11 of their stay in the intensive care unit and required an additional 5.5 days of mechanical ventilation; those who could not be weaned were not ready for weaning until day 17. All patients initially had increases in oxygen consumption during weaning; those who were successfully weaned had decreases before extubation. Respiratory rate, maximal inspiratory pressure, the ratio of Pao2 to fraction of inspired oxygen, and mean arterial pressure were higher in patients who could be weaned, and oxygen cost of breathing and central venous pressure were lower
Further study of weaning in older adults is warranted. |
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AbstractList | • Background As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation.
• Objective To describe temporal changes in pulmonary and systemic variables in older adults receiving long-term mechanical ventilation.
• Methods After 3 days of unsuccessful attempts at weaning from ventilatory support, 10 trauma and surgical patients more than 60 years old were monitored daily. Previously reported predictors of the duration of mechanical ventilation and weaning outcome were measured, including hemodynamic and gas exchange variables, oxygen cost of breathing, and the score on the Burns Weaning Assessment Program.
• Results The 6 patients who could be weaned from ventilatory support were younger (median age, 71.5 years) than the 4 patients who could not be weaned (median age, 80 years). Patients who could be weaned were ready for weaning by day 11 of their stay in the intensive care unit and required an additional 5.5 days of mechanical ventilation; those who could not be weaned were not ready for weaning until day 17. All patients initially had increases in oxygen consumption during weaning; those who were successfully weaned had decreases before extubation. Respiratory rate, maximal inspiratory pressure, the ratio of Pao2 to fraction of inspired oxygen, and mean arterial pressure were higher in patients who could be weaned, and oxygen cost of breathing and central venous pressure were lower.
• Conclusion Further study of weaning in older adults is warranted. BACKGROUNDAs older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation.OBJECTIVETo describe temporal changes in pulmonary and systemic variables in older adults receiving long-term mechanical ventilation.METHODSAfter 3 days of unsuccessful attempts at weaning from ventilatory support, 10 trauma and surgical patients more than 60 years old were monitored daily. Previously reported predictors of the duration of mechanical ventilation and weaning outcome were measured, including hemodynamic and gas exchange variables, oxygen cost of breathing, and the score on the Burns Weaning Assessment Program.RESULTSThe 6 patients who could be weaned from ventilatory support were younger (median age, 71.5 years) than the 4 patients who could not be weaned (median age, 80 years). Patients who could be weaned were ready for weaning by day 11 of their stay in the intensive care unit and required an additional 5.5 days of mechanical ventilation; those who could not be weaned were not ready for weaning until day 17. All patients initially had increases in oxygen consumption during weaning; those who were successfully weaned had decreases before extubation. Respiratory rate, maximal inspiratory pressure, the ratio of Pao2 to fraction of inspired oxygen, and mean arterial pressure were higher in patients who could be weaned, and oxygen cost of breathing and central venous pressure were lowerCONCLUSIONFurther study of weaning in older adults is warranted. BACKGROUND: As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation. OBJECTIVE: To describe temporal changes in pulmonary and systemic variables in older adults receiving long-term mechanical ventilation. METHODS: After 3 days of unsuccessful attempts at weaning from ventilatory support, 10 trauma and surgical patients more than 60 years old were monitored daily. Previously reported predictors of the duration of mechanical ventilation and weaning outcome were measured, including hemodynamic and gas exchange variables, oxygen cost of breathing, and the score on the Burns Weaning Assessment Program. RESULTS: The 6 patients who could be weaned from ventilatory support were younger (median age, 71.5 years) than the 4 patients who could not be weaned (median age, 80 years). Patients who could be weaned were ready for weaning by day 11 of their stay in the intensive care unit and required an additional 5.5 days of mechanical ventilation; those who could not be weaned were not ready for weaning until day 17. All patients initially had increases in oxygen consumption during weaning; those who were successfully weaned had decreases before extubation. Respiratory rate, maximal inspiratory pressure, the ratio of Pao2 to fraction of inspired oxygen, and mean arterial pressure were higher in patients who could be weaned, and oxygen cost of breathing and central venous pressure were lower CONCLUSION: Further study of weaning in older adults is warranted. As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation. To describe temporal changes in pulmonary and systemic variables in older adults receiving long-term mechanical ventilation. After 3 days of unsuccessful attempts at weaning from ventilatory support, 10 trauma and surgical patients more than 60 years old were monitored daily. Previously reported predictors of the duration of mechanical ventilation and weaning outcome were measured, including hemodynamic and gas exchange variables, oxygen cost of breathing, and the score on the Burns Weaning Assessment Program. The 6 patients who could be weaned from ventilatory support were younger (median age, 71.5 years) than the 4 patients who could not be weaned (median age, 80 years). Patients who could be weaned were ready for weaning by day 11 of their stay in the intensive care unit and required an additional 5.5 days of mechanical ventilation; those who could not be weaned were not ready for weaning until day 17. All patients initially had increases in oxygen consumption during weaning; those who were successfully weaned had decreases before extubation. Respiratory rate, maximal inspiratory pressure, the ratio of Pao2 to fraction of inspired oxygen, and mean arterial pressure were higher in patients who could be weaned, and oxygen cost of breathing and central venous pressure were lower Further study of weaning in older adults is warranted. |
Audience | Professional Academic |
Author | Epstein, Carol Diane Peerless, Joel R El-Mokadem, Naglaa |
Author_xml | – sequence: 1 givenname: Carol Diane surname: Epstein fullname: Epstein, Carol Diane organization: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA – sequence: 2 givenname: Naglaa surname: El-Mokadem fullname: El-Mokadem, Naglaa – sequence: 3 givenname: Joel R surname: Peerless fullname: Peerless, Joel R |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/12102438$$D View this record in MEDLINE/PubMed |
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Snippet | As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from... • Background As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning... BACKGROUND: As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning... BACKGROUNDAs older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from... |
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SubjectTerms | Aged Aged patients Aged, 80 and over Artificial respiration Care and treatment Critical Care - methods Female Humans Intensive Care Units Intubation Male Methods Middle Aged Monitoring, Physiologic - nursing Nursing Pilot Projects Safety and security measures Time Trachea Ventilator weaning Ventilator Weaning - methods Ventilator Weaning - nursing |
Title | Weaning older patients from long-term mechanical ventilation: a pilot study |
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