Prof. Javier Belda has recently published an editorial on the need to find an index that guarantees with greater security the moment of the withdrawal of mechanical ventilation to patients assisted in intensive care, commenting on an original article recently published.
The process of removing mechanical ventilation involves a two-step strategy. Initially, the time of onset of disconnection is identified through clinical evaluation and objective assessment of hemodynamics, gas exchange, adequate stimulation, and lung function. Next, a spontaneous breathing trial (SBT) should be performed, which is the most commonly used diagnostic test to evaluate preparation for extubation. The goal of SBT is to assess the safety of interrupting invasive ventilation.
Premature disruption or failure of withdrawal, defined as the inability to maintain spontaneous and unassisted breathing within 48 hours after the discontinuation of mechanical ventilation. Non-response occurs in 10-20% of extubated patients, leading to very poor outcomes. This may justify that disconnection of ventilation tends to be delayed in clinical practice. There is much evidence showing that the time spent in the disconnection process could be as high as 50% of the total duration of mechanical ventilation. Therefore, any research on this topic that adds new knowledge to it is welcome.
Access to the paper:
The quest for the perfect weaning index. Ferrando C, Mellado R, Belda FJ. Minerva Anestesiol. 2019 Mar 12. doi: 10.23736/S0375-9393.19.13593-6.