Intensive care units weaning

In a survey of intensive care units in the UK, more than two-thirds of the respondents would have chosen suxamethonium in a clinical scenario requiring re-intubation in a patient with abdominal sepsis and weaning failure after 20 days of ICU stay (198). The authors concluded that there is a lack of appreciation of the dangers of suxamethonium in critically ill patients in intensive care units. 

The safety and efficacy of nalbuphine, with respect to the treatment of pediatric pain, have not been fully established. For patients older than 1 year of age, doses of 0.1-0.2 mg/kg SQ/IM/IV every 3-4 hours are utilized, and individualized, as above [6]. The maximum dose is 20 mg/administration and the daily total dose should not exceed 160 mg. Nalbuphine, in doses of 0.05-0.1 mg/kg SQ/IM/IV, has been used to facilitate weaning from mechanical ventilation in the pediatric intensive care unit setting. Nalbuphine is also used to relieve pruritus, caused by narcotic administration, in this population as well as in adults. 

The prevalence of PMV depends upon the definition used. Most patients (65-85%) are easily weaned from ventilatory support after less than one week. In a multicenter observational study of >5000 medical and surgical ICU patients, 25% required greater than seven days of MV (23). In the acute physiology and chronic health evaluation III (APACHE III) database of medical and surgical ICUs, one in five patients remained ventilated for at least seven days (24). When the definition of PMV is extended to >21 days, the incidence predictably falls. In a cohort of nearly 600 medical patients admitted to a tertiary care medical intensive care unit, approximately 10% remained invasively ventilated at day 21... 

Rothenhausler HB, Ehrentraut S, von Degenfeld G, et aL Treatment of depression with methylphenidate in patients difficult to wean from mechanical ventilation in the intensive care unit. J Clin Psychiatry 2000 61(10) 750-755. 

Pulmonary and Respiratory Intensive Care Unit-University Hospital Pisa, Italy and Pulmonary Rehabilitation and Weaning Center, Auxilium Vitae, Volterra (PI), Italy... 

CAVC unit Rehabilitation Stable Intensive nursing and respiratory care, patient focused, lower cost Unable to provide intensive care, limited weaning... 

The 1960s witnessed the continued support of some polio patients at home, as well as the introduction of mouthpiece ventilation for long term, even continuous, support at some specialized rehabilitation hospitals (4). The 1960s also ushered in intensive care units (ICUs) that served as specialized centers to treat patients with acute respiratory failure. Sophisticated mechanical ventilators were developed to treat these patients. Some of whom failed to wean and often spent weeks or months in these units because no other facilities were available to adequately care for them. 

Many of these patients remained in intensive care unit (ICU), although their needs are quite different from those of acute ICU patients. Specialized venues, management strategies, and reimbursement schemes for such patients are rapidly emerging (4). Although weaning centers provide better and more cost-effective care (5), little information has been published in South America on the outcomes of these patients. 

Ankrom reported a five-year experience in a 19-bed chronic ventilator unit located in a SNF, for which there were no predetermined requirements for VAI admission except that the patients do not require intensive monitoring, nursing, or technology (32). Patients had failed weaning trials over several weeks, had a tracheostomy and required LTMV. Of the 95 VAIs, 26 lived more than 12 months 15 patients were weaned, 13 elected to discontinue ventilator support, and 13 were still alive in the nursing home but required LTMV. The one-year survival in a SNF was similar to that of an ICU. Care of VAI in a SNF is less costly than at home (33). 

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