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Weaning from mechanical ventilation and sedation

Luetz, Alawi; Goldmann, Anton; Weber-Carstens, Steffen; Spies, Claudia

Current Opinion in Anaesthesiology: April 2012 - Volume 25 - Issue 2 - p 164–169
doi: 10.1097/ACO.0b013e32834f8ce7
INTENSIVE CARE AND RESUSCITATION: Edited by Paolo Pelosi and Marcelo Gama de Abreu

Purpose of review Guidelines for weaning from sedation and weaning from ventilator gained increasing interest in recent years. This includes patients with acute respiratory distress syndrome, as well as other mechanically ventilated patients. This review will give an overview of the current literature and practice guidelines in ventilator and sedation weaning.

Recent findings Sedation and ventilator weaning are closely linked. Weaning protocols for both sedation and ventilator weaning should be implemented in daily routine. The essential element of such algorithm should be a daily spontaneous awakening trial and spontaneous breathing trial. Furthermore, regularly monitoring for deepness of sedation and delirium should be implemented. Too deep sedation, as well as prolonged delirium is associated with higher mortality.

Summary The most important conclusion we come to from recent randomized controlled trials is that only using an integrative algorithm for sedation and ventilator weaning can improve survival of ICU patients.

Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitaetsmedizin Berlin, Berlin, Germany

Correspondence to Claudia Spies, MD, PhD, Professor of Anesthesiology and Intensive Care Medicine, Head of the Department, Department of Anesthesiology and Intensive Care Medicine, Campus Virchow Klinikum and Campus Charité Mitte, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49 30 450 551 001/2; fax: +49 30 450 551 909; e-mail: claudia.spies@charite.de

© 2012 Lippincott Williams & Wilkins, Inc.