Liberation from Mechanical Ventilation: Established and New Insights

Karen E.A. Burns; Arnav Agarwal; Karen J. Bosma; Dipayan Chaudhuri; Timothy D. Girard

doi:10.1055/s-0042-1747929

Seminars in Respiratory and Critical Care Medicine, Inhaltsverzeichnis

Semin Respir Crit Care Med 2022; 43(03): 461-470
DOI: 10.1055/s-0042-1747929

Review Article

Liberation from Mechanical Ventilation: Established and New Insights

Authors

Karen E.A. Burns

¹Interdepartmental Division of Critical Care Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

²Departments of Critical Care and Medicine, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada

³Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

⁴Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
Arnav Agarwal

³Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

⁵Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Karen J. Bosma

⁶Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, and London Health Sciences Centre, London, Ontario, Canada
Dipayan Chaudhuri

³Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

⁷Departments of Critical Care Medicine and Medicine, McMaster University, Hamilton, Ontario, Canada
Timothy D. Girard

⁸The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Abstract

A substantial proportion of critically ill patients require ventilator support with the majority requiring invasive mechanical ventilation. Timely and safe liberation from invasive mechanical ventilation is a critical aspect of patient care in the intensive care unit (ICU) and is a top research priority for patients and clinicians. In this article, we discuss how to (1) identify candidates for liberation from mechanical ventilation, (2) conduct spontaneous breathing trials (SBTs), and (3) optimize patients for liberation from mechanical ventilation. We also discuss the roles for (4) extubation to noninvasive ventilation and (5) newer modes of mechanical ventilation during liberation from mechanical ventilation. We conclude that, though substantial progress has been made in identifying patients who are likely to be liberated (e.g., through the use of SBTs) and management strategies that speed liberation from the ventilator (e.g., protocolized SBTs, lighter sedation, and early mobilization), many important questions regarding liberation from mechanical ventilation in clinical practice remain unanswered.

Keywords

acute respiratory failure - mechanical ventilation - ventilator support

Volltext

Referenzen

References
1 Melsen WG, Rovers MM, Groenwold RH. et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis 2013; 13 (08) 665-671
2 Herridge MS, Tansey CM, Matté A. et al. Canadian Critical Care Trials Group. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364 (14) 1293-1304
3 Farhan H, Moreno-Duarte I, Latronico N, Zafonte R, Eikermann M. Acquired muscle weakness in the surgical intensive care unit: nosology, epidemiology, diagnosis, and prevention. Anesthesiology 2016; 124 (01) 207-234
4 Dowdy DW, Eid MP, Sedrakyan A. et al. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med 2005; 31 (05) 611-620
5 Combes A, Costa MA, Trouillet JL. et al. Morbidity, mortality, and quality-of-life outcomes of patients requiring ≥14 days of mechanical ventilation. Crit Care Med 2003; 31 (05) 1373-1381
6 Jubran A, Lawm G, Kelly J. et al. Depressive disorders during weaning from prolonged mechanical ventilation. Intensive Care Med 2010; 36 (05) 828-835
7 Ely EW, Gautam S, Margolin R. et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001; 27 (12) 1892-1900
8 Cuthbertson BH, Hull A, Strachan M, Scott J. Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med 2004; 30 (03) 450-455
9 Jubran A, Lawm G, Duffner LA. et al. Post-traumatic stress disorder after weaning from prolonged mechanical ventilation. Intensive Care Med 2010; 36 (12) 2030-2037
10 Pandharipande PP, Girard TD, Jackson JC. et al. BRAIN-ICU Study Investigators. Long-term cognitive impairment after critical illness. N Engl J Med 2013; 369 (14) 1306-1316
11 Boles JM, Bion J, Connors A. et al. Weaning from mechanical ventilation. Eur Respir J 2007; 29 (05) 1033-1056
12 Esteban A, Ferguson ND, Meade MO. et al. VENTILA Group. Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med 2008; 177 (02) 170-177
13 Zein H, Baratloo A, Negida A, Safari S. Ventilator weaning and spontaneous breathing trials; an educational review. Emergency (Tehran) 2016; 4 (02) 65-71
14 MacIntyre NR, Cook DJ, Ely Jr EW. et al. American College of Chest Physicians, American Association for Respiratory Care, American College of Critical Care Medicine. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001; 120 (Suppl. 06) 375S-395S
15 Vallverdú I, Calaf N, Subirana M, Net A, Benito S, Mancebo J. Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med 1998; 158 (06) 1855-1862
16 Schmidt GA, Girard TD, Kress JP. et al. ATS/CHEST Ad Hoc Committee on Liberation from Mechanical Ventilation in Adults. Official executive summary of an American Thoracic Society/American College of Chest Physicians clinical practice guideline: Liberation from mechanical ventilation in critically ill adults. Am J Respir Crit Care Med 2017; 195 (01) 115-119
17 Esteban A, Frutos F, Tobin MJ. et al. Spanish Lung Failure Collaborative Group. A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 1995; 332 (06) 345-350
18 Ely EW, Baker AM, Dunagan DP. et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996; 335 (25) 1864-1869
19 Girard TD, Kress JP, Fuchs BD. et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 2008; 371 (9607): 126-134
20 Girard TD, Alhazzani W, Kress JP. et al. ATS/CHEST Ad Hoc Committee on Liberation from Mechanical Ventilation in Adults. An official American Thoracic Society/American College of Chest Physicians clinical practice guideline: liberation from mechanical ventilation in critically ill adults. Rehabilitation protocols, ventilator liberation protocols, and cuff leak tests. Am J Respir Crit Care Med 2017; 195 (01) 120-133
21 Béduneau G, Pham T, Schortgen F. et al. WIND (Weaning according to a New Definition) Study Group and the REVA (Réseau Européen de Recherche en Ventilation Artificielle) Network ‡. Epidemiology of weaning outcome according to a new definition. The WIND Study. Am J Respir Crit Care Med 2017; 195 (06) 772-783
22 Thille AW, Richard JC, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med 2013; 187 (12) 1294-1302
23 Baptistella AR, Sarmento FJ, da Silva KR. et al. Predictive factors of weaning from mechanical ventilation and extubation outcome: a systematic review. J Crit Care 2018; 48: 56-62
24 Brochard L, Rauss A, Benito S. et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994; 150 (04) 896-903
25 Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991; 324 (21) 1445-1450
26 Meade M, Guyatt G, Cook D. et al. Predicting success in weaning from mechanical ventilation. Chest 2001; 120 (Suppl. 06) 400S-424S
27 Trivedi V, Chaudhuri D, Jinah R. et al. The usefulness of the Rapid Shallow Breathing Index in predicting successful extubation: a systematic review and meta-analysis. Chest 2022; 161 (01) 97-111
28 Tanios MA, Nevins ML, Hendra KP. et al. A randomized, controlled trial of the role of weaning predictors in clinical decision making. Crit Care Med 2006; 34 (10) 2530-2535
29 Burns KEA, Raptis S, Nisenbaum R. et al. International practice variation in weaning critically ill adults from invasive mechanical ventilation. Ann Am Thorac Soc 2018; 15 (04) 494-502
30 Sklar MC, Burns K, Rittayamai N. et al. Effort to breathe with various spontaneous breathing trial techniques. A physiologic meta-analysis. Am J Respir Crit Care Med 2017; 195 (11) 1477-1485
31 Burns KEA, Soliman I, Adhikari NKJ. et al. Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis. Crit Care 2017; 21 (01) 127
32 Ouellette DR, Patel S, Girard TD. et al. Liberation from mechanical ventilation in critically ill adults: An official American College of Chest Physicians/American Thoracic Society clinical practice guideline: inspiratory pressure augmentation during spontaneous breathing trials, protocols minimizing sedation, and noninvasive ventilation immediately after extubation. Chest 2017; 151 (01) 166-180
33 Subirà C, Hernández G, Vázquez A. et al. Effect of pressure support vs T-piece ventilation strategies during spontaneous breathing trials on successful extubation among patients receiving mechanical ventilation: a randomized clinical trial. JAMA 2019; 321 (22) 2175-2182
34 Esteban A, Alía I, Tobin MJ. et al. Spanish Lung Failure Collaborative Group. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Am J Respir Crit Care Med 1999; 159 (02) 512-518
35 Chawla K, Kupfer Y, Goldman I. et al. The spontaneous breathing trial: how long?. Am J Respir Crit Care Med 2001; 163: A892
36 Perren A, Domenighetti G, Mauri S, Genini F, Vizzardi N. Protocol-directed weaning from mechanical ventilation: clinical outcome in patients randomized for a 30-min or 120-min trial with pressure support ventilation. Intensive Care Med 2002; 28 (08) 1058-1063
37 Blackwood B, Burns KE, Cardwell CR, O'Halloran P. Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. Cochrane Database Syst Rev 2014; 2014 (11) CD006904
38 Fan E, Zakhary B, Amaral A. et al. Liberation from mechanical ventilation in critically ill adults. An official ATS/ACCP clinical practice guideline. Ann Am Thorac Soc 2017; 14 (03) 441-443
39 Lellouche F, Mancebo J, Jolliet P. et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med 2006; 174 (08) 894-900
40 Yang T, Li Z, Jiang L, Wang Y, Xi X. Risk factors for intensive care unit-acquired weakness: A systematic review and meta-analysis. Acta Neurol Scand 2018; 138 (02) 104-114
41 Winkelman C. Bed rest in health and critical illness: a body systems approach. AACN Adv Crit Care 2009; 20 (03) 254-266
42 Ochoa ME, Marín MdelC, Frutos-Vivar F. et al. Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis. Intensive Care Med 2009; 35 (07) 1171-1179
43 Zhou T, Zhang HP, Chen WW. et al. Cuff-leak test for predicting postextubation airway complications: a systematic review. J Evid Based Med 2011; 4 (04) 242-254
44 Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med 2001; 163 (02) 540-577
45 Appendini L, Patessio A, Zanaboni S. et al. Physiologic effects of positive end-expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1994; 149 (05) 1069-1076
46 Nava S, Ambrosino N, Rubini F. et al. Effect of nasal pressure support ventilation and external PEEP on diaphragmatic activity in patients with severe stable COPD. Chest 1993; 103 (01) 143-150
47 Rathgeber J, Schorn B, Falk V, Kazmaier S, Spiegel T, Burchardi H. The influence of controlled mandatory ventilation (CMV), intermittent mandatory ventilation (IMV) and biphasic intermittent positive airway pressure (BIPAP) on duration of intubation and consumption of analgesics and sedatives. A prospective analysis in 596 patients following adult cardiac surgery. Eur J Anaesthesiol 1997; 14 (06) 576-582
48 Criner GJ, Tzouanakis A, Kreimer DT. Overview of improving tolerance of long-term mechanical ventilation. Crit Care Clin 1994; 10 (04) 845-866
49 Burns KEA, Stevenson J, Laird M. et al. Non-invasive ventilation versus invasive weaning in critically ill adults: a systematic review and meta-analysis. Thorax 2021:thoraxjnl-2021-216993
50 Lellouche F, Brochard L. Advanced closed loops during mechanical ventilation (PAV, NAVA, ASV, SmartCare). Best Pract Res Clin Anaesthesiol 2009; 23 (01) 81-93
51 Fernández J, Miguelena D, Mulett H, Godoy J, Martinón-Torres F. Adaptive support ventilation: State of the art review. Indian J Crit Care Med 2013; 17 (01) 16-22
52 Younes M. Proportional assist ventilation, a new approach to ventilatory support. Theory. Am Rev Respir Dis 1992; 145 (01) 114-120
53 Younes M, Puddy A, Roberts D. et al. Proportional assist ventilation. Results of an initial clinical trial. Am Rev Respir Dis 1992; 145 (01) 121-129
54 Kondili E, Prinianakis G, Alexopoulou C, Vakouti E, Klimathianaki M, Georgopoulos D. Respiratory load compensation during mechanical ventilation–proportional assist ventilation with load-adjustable gain factors versus pressure support. Intensive Care Med 2006; 32 (05) 692-699
55 Bosma K, Ferreyra G, Ambrogio C. et al. Patient-ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation. Crit Care Med 2007; 35 (04) 1048-1054
56 Bosma KJ, Read BA, Bahrgard Nikoo MJ, Jones PM, Priestap FA, Lewis JF. A pilot randomized trial comparing weaning from mechanical ventilation on pressure support versus proportional assist ventilation. Crit Care Med 2016; 44 (06) 1098-1108
57 Akoumianaki E, Prinianakis G, Kondili E, Malliotakis P, Georgopoulos D. Physiologic comparison of neurally adjusted ventilator assist, proportional assist and pressure support ventilation in critically ill patients. Respir Physiol Neurobiol 2014; 203: 82-89
58 Wrigge H, Golisch W, Zinserling J, Sydow M, Almeling G, Burchardi H. Proportional assist versus pressure support ventilation: effects on breathing pattern and respiratory work of patients with chronic obstructive pulmonary disease. Intensive Care Med 1999; 25 (08) 790-798
59 Kataoka J, Kuriyama A, Norisue Y, Fujitani S. Proportional modes versus pressure support ventilation: a systematic review and meta-analysis. Ann Intensive Care 2018; 8 (01) 123
60 Tirupakuzhi Vijayaraghavan BK, Hamed S, Jain A. et al. Evidence supporting clinical use of proportional assist ventilation: a systematic review and meta-analysis of clinical trials. J Intensive Care Med 2020; 35 (07) 627-635
61 Ou-Yang LJ, Chen PH, Jhou HJ, Su VY, Lee CH. Proportional assist ventilation versus pressure support ventilation for weaning from mechanical ventilation in adults: a meta-analysis and trial sequential analysis. Crit Care 2020; 24 (01) 556
62 Jhou HJ, Chen PH, Ou-Yang LJ, Lin C, Tang SE, Lee CH. Methods of weaning from mechanical ventilation in adult: a network meta-analysis. Front Med (Lausanne) 2021; 8: 752984
63 Pantazopoulos I, Mavrovounis G, Mermiri M, Kampolis C. Proportional assist ventilation versus pressure support ventilation for weaning from mechanical ventilation in adults: weaning success and mortality. Crit Care 2021; 25 (01) 200
64 Sinderby C, Navalesi P, Beck J. et al. Neural control of mechanical ventilation in respiratory failure. Nat Med 1999; 5 (12) 1433-1436
65 Jonkman AH, Rauseo M, Carteaux G. et al. Proportional modes of ventilation: technology to assist physiology. Intensive Care Med 2020; 46 (12) 2301-2313
66 Levine S, Nguyen T, Taylor N. et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 2008; 358 (13) 1327-1335
67 Di Mussi R, Spadaro S, Mirabella L. et al. Impact of prolonged assisted ventilation on diaphragmatic efficiency: NAVA versus PSV. Crit Care 2016; 20: 1
68 Liu L, Xu X, Sun Q. et al. Neurally adjusted ventilatory assist versus pressure support ventilation in difficult weaning: a randomized trial. Anesthesiology 2020; 132 (06) 1482-1493
69 Hadfield DJ, Rose L, Reid F. et al. Neurally adjusted ventilatory assist versus pressure support ventilation: a randomized controlled feasibility trial performed in patients at risk of prolonged mechanical ventilation. Crit Care 2020; 24 (01) 220
70 Kacmarek RM, Villar J, Parrilla D. et al. NAVa In Acute respiraTORy failure (NAVIATOR) Network. Neurally adjusted ventilatory assist in acute respiratory failure: a randomized controlled trial. Intensive Care Med 2020; 46 (12) 2327-2337
71 Yuan X, Lu X, Chao Y. et al. Neurally adjusted ventilatory assist as a weaning mode for adults with invasive mechanical ventilation: a systematic review and meta-analysis. Crit Care 2021; 25 (01) 222
72 Tehrani FT. Automatic control of an artificial respirator. Conf Proc IEEE Eng Med Biol Soc 1991; 13: 1738-1739
73 Otis AB, Fenn WO, Rahn H. Mechanics of breathing in man. J Appl Physiol 1950; 2 (11) 592-607
74 Mead J. Control of respiratory frequency. J Appl Physiol 1960; 15: 325-336
75 Kirakli C, Naz I, Ediboglu O, Tatar D, Budak A, Tellioglu E. A randomized controlled trial comparing the ventilation duration between adaptive support ventilation and pressure assist/control ventilation in medical patients in the ICU. Chest 2015; 147 (06) 1503-1509
76 Kirakli C, Ozdemir I, Ucar ZZ, Cimen P, Kepil S, Ozkan SA. Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial. Eur Respir J 2011; 38 (04) 774-780
77 Botta M, Wenstedt EFE, Tsonas AM. et al. Effectiveness, safety and efficacy of INTELLiVENT-adaptive support ventilation, a closed-loop ventilation mode for use in ICU patients—a systematic review. Expert Rev Respir Med 2021; 15 (11) 1403-1413
78 Rose L, Schultz MJ, Cardwell CR, Jouvet P, McAuley DF, Blackwood B. Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children: a Cochrane systematic review and meta-analysis. Crit Care 2015; 19: 48