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A case series of a pav+ weaning protocol in an acute care environment demonstrating an absence of weaning failure
Intensive Care Medicine Experimentalvolume 3, Article number: A1008 (2015)
Most patients undergoing mechanical ventilation (MV) in critical care units are liberated from the ventilator within a median of 7 days. Unfortunately, some patients experience difficulty in liberation from MV during their ICU stays and require extended time on MV. It has been estimated that 40% of the patient's duration on the ventilator is spent weaning. Moreover, although patients requiring prolonged mechanical ventilation represent approximately 6% of all ventilated patients, they consume 37% of intensive care unit resources. Therefore, accelerating the liberation of prolonged weaning patients from MV improves patient care and could yield significant economic benefits.
Which weaning strategy is “best” is controversial. Proportional Assist Ventilation (PAV+) has many aspects that are theoretically beneficial as part of a difficult weaning protocol.
Single center case series of patients undergoing a PAV+ protocolized wean from an 18 bed mixed medical/surgical/ trauma Canadian tertiary care ICU.
Over the 39 month (3.25 year) period 46 patients underwent a slow wean, 40 of whom spent greater than 70% of their time weaning in a PAV+ mode. During weaning from MV there were 4/40 (10%) deaths in the PAV+ group, despite a high admitting APACHE II score. All patients in the PAV+ group who survived were successfully weaned from MV over a median of 13.3 (9.2-20) days.
Although this study was conducted in an acute hospital context that is significantly different from Long Term Acute Care Hospitals, it raises the possibility that a PAV+ weaning protocol could be superior to PSV or t piece weaning strategies. Further studies are needed.
Study funded by grant from Covidien.
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