Endotracheal weaning

Tracheostomy tubes are associated with long-term complications, particularly related to cuff inflation (4). As this population has already failed endotracheal weaning, they must be approached in a systematic way to optimize the likelihood of success. Ceriana et al. have suggested a decision tree to help with this process (5). 

Many lives are saved in critically ill patients by the introduction of an endotracheal tube (ETT) and mechanical ventilation. Most patients are capable of weaning from such invasive support once the acute process has resolved. Approximately 10% to 24% (1,2) are unable to wean from endotracheal intubation and require the surgical placement of a tracheostomy. Although timing of tracheostomy placement is controversial, a tracheostomy may offer advantages over more prolonged intubation (3). 

Acutely ill but in recovery phase of illness Hemodynamically stable (may be on low dose vasopressors) Intubated with tracheostomy or endotracheal tube Requires high level of ventilator support Failed weaning trials in ICU Potential to wean in 21 days Plan estabhshed for overall medical care Formal rehabihtation evaluation completed Evaluation by the RCU team before transfer Transferred to the service of an attending pulmonologist Family meeting prior to transfer to establish expectations... 

---