8(th) International conference on management and rehabilitation of chronic respiratory failure: the long summaries – Part 3

Ambrosino, Nicolino; Casaburi, Richard; Chetta, Alfredo; Clini, Enrico; Donner, Claudio F.; Dreher, Michael; Goldstein, Roger; Jubran, Amal; Nici, Linda; Owen, Caroline A.; Rochester, Carolyn; Tobin, Martin J.; Vagheggini, Guido; Vitacca, Michele; ZuWallack, Richard

One hundred and sixty patients did not develop distress during the five days and were considered to have been successfully weaned and were not randomized. Three hundred and sixteen patients developed respiratory distress during the 5-day period and were judged to have failed the screening procedure and were randomized to wean with pressure support or trach collar. Patients randomized to trach collar were disconnected from the ventilator and allowed to breathe through the tracheostomy. During the first day, the patient was allowed to breathe unassisted for a maximum of 12 h. The patient was then reconnected to the ventilator and assist-control ventilation was instituted for the next 12 h. On the second day, the 12-h trach-collar challenge followed by assist-control ventilation was repeated. On the third day, the patient was disconnected from the ventilator and allowed to breathe unassisted through the trach collar up to 24 h. In the pressure-support arm, on the first day the initial level was titrated to achieve a total respiratory frequency of less than 30 breaths per minute. Attempts were made to decrease pressure support by 2 cmH 2 O three times each day. When a patient was able to tolerate pressure support of no more than 6 cmH 2 O for at least 12 h, the ventilator was disconnected and the patient allowed to breathe unassisted through the tracheostomy up to a maximum of 24 h each day.