Protocol-directed weaning a process of continuous performance improvement 英文参考文献.docVIP

Critical Care April 2005 Vol 9 No 2 Ramachandran et al. Commentary Protocol-directed weaning: a process of continuous performance improvement Venkat Ramachandran1, Mary Jo Grap2 and Curtis N Sessler1 1The Department of Medicine, Medical College of Virginia Campus of the Virginia Commonwealth University, Richmond, Virginia, USA 2School of Nursing, Medical College of Virginia Campus of the Virginia Commonwealth University, Richmond, Virginia, USA Corresponding author: Curtis N Sessler, csessler@ Published online: 28 January 2005 Critical Care 2005, 9:138-140 (DOI 10.1186/cc3053) This article is online at /content/9/2/138 ? 2005 BioMed Central Ltd See related research by Tonnelier et al. in this issue [/content/9/2/R83] Abstract artificial ventilatory support until independence is achieved, namely ‘weaning’, to that of timely recognition of the patient’s The use of a nursing-directed and/or respiratory therapist-directed protocol in many intensive care units for weaning from mechanical ventilation is associated with a shorter duration of ventilation and length of stay in the ICU. Most protocols have two formal components: the daily screening of a set of simple observations or interventions to identify readiness to proceed, followed by a spontaneous breathing trial that tests the patient’s ability to breathe independently. The daily screen is designed to identify of consciousness, oxygenation, ventilation, and airway patency and protection. However, one must avoid selecting criteria that are too restrictive, potentially delaying the discontinuation of ventilation. ability to breathe independently followed by rapid discontinuation [7]. Ely and colleagues [2] first showed that a combination of a daily screening checklist of easily measured parameters, followed by a demonstration of tolerance of spontaneous independent breathing was highly predictive of extubation success. I