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

What explains the faster pace of weaning with a trach collar than with pressure support? One explanation lies with how doctors make decisions. During a trach-collar challenge, the amount of respiratory work is determined solely by the patientthe ventilator cannot do any work. As such, a physician observing a patient breathe through a trach collar has a completely clear view of the patient's respiratory capabilities. During pressure support weaning, a clinician's ability to judge weanability is clouded because the patient is receiving ventilator assistance and it is extremely difficult to distinguish between how much work the patient is doing and how much work the ventilator is doing [66] . Accordingly, clinicians are more likely to accelerate the weaning process in patients who perform unexpectedly well during a trach-collar challenge than when a low level of pressure support is being used. This notion is borne out by the Kaplan-Meier plot, which shows that the superiority of trach collar over pressure support was evident within the first ten days of the study [63] .