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Discontinuing Mechanical Ventilatory Support: Removing Positive Pressure Ventilation vs Removing the Artificial Airway

Neil MacIntyre, MD, FCCP
Author and Funding Information

Affiliations: Durham, NC
 ,  Dr. MacIntyre is Professor, Duke University Medical Center.

Correspondence to: Neil MacIntyre, MD, FCCP, Duke University Medical Center, Durham, NC 27710; e-mail: neil.macintyre@duke.edu



Chest. 2006;130(6):1635-1636. doi:10.1378/chest.130.6.1635
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When the underlying respiratory failure begins to stabilize and reverse in patients requiring mechanical ventilation, consideration for ventilator discontinuation should begin. A multisociety-sponsored evidence-based task force (EBTF)1 has recommended that a patient be considered for withdrawal assessments when the following occur: (1) the lung injury is stable/resolving; (2) the gas exchange is adequate, with low positive end-expiratory pressure/fraction of inspired oxygen requirements (eg, positive end-expiratory pressure < 5 to 8 cm H2O; fraction of inspired oxygen, < 0.4 to 0.5); (3) hemodynamics are stable without a need for pressors; and (4) there is the capability to initiate spontaneous breaths. This information is usually readily available at the bedside, and the EBTF recommended that these issues be assessed daily.,1 A variation of this concept could be taken to the postsurgical arena, where respiratory recovery is often rapid and this assessment could be done on a more frequent basis.

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