Liberation of the Patient From Mechanical Ventilation

doi:10.1001/jama.1987.03390120083029

Liberation of the Patient From Mechanical Ventilation

Jesse B. Hall, MD;
Lawrence D. H. Wood, MD, PhD

From the Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago.

Abstract

Discontinuation of mechanical ventilation is too frequently difficult and frustrating for the patient and the clinician alike. With the view that expeditious withdrawal of mechanical support is often a mirror-image exercise requiring reversal of the factors that led to respiratory failure, we begin with a discussion of the various pathophysiologies of respiratory failure. We then describe an approach emphasizing assessment of respiratory load and neuromuscular function at the bedside, with strategies outlined for diminishing mechanical load while conditioning and strengthening respiratory muscles to the point that spontaneous ventilation can be sustained.

(JAMA 1987;257:1621-1628)

Footnotes

Reprint requests to Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60635 (Dr Hall).