Getting off the ventilator

File:Intubation.jpg

It’s often all lights and sirens when people are being intubated in an emergency situation, but once the intensive care unit has taken over and got things under control, you need to make a decision to get patients off the breather.

This month, there’s a nice review in the New England Journal of Medicine running through this. There are quite a few factors to balance – particularly between the load on the respiratory system, vs. the underlying capacity for it to cope. They’ve also identified several important risk factors for failure, such as heart failure, advanced age, and a weak cough, but also more objective markers like APACHE > 12 on the day of extubation, or a PaCO2 > 45 post.

A nice overview, here.

 

 

source | New England Journal of Medicine

image | US Marines

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