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Evaluation of Criteria for Discontinuing Mechanical Ventilatory Support
Lt Comdr S. Michael Millbern, MC;
John B. Downs, MD;
Linda C. Jumper, CRTT;
Jerome H. Modell, MD
Arch Surg. 1978;113(12):1441-1443.
Abstract
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• Thirty-three patients who required short-term postoperative mechanical ventilatory support were studied to compare different criteria established to initiate weaning from mechanical ventilation. Intermittent mandatory ventilation criteria (ie, decreasing mechanical respirator rate as long as the arterial (pHa) remains above 7.35) and conventional criteria (ie, vital capacity greater than 15 ml/kg and peak negative pressure greater than 20 cm H2O) were compared to determine which would more rapidly predict a patient's ability to sustain total spontaneous respiration. All patients were eventually weaned from mechanical ventilation and had their tracheas extubated. Twenty-one patients maintained a pHa of greater than 7.35 during total spontaneous ventilation before they would, or could, meet conventional criteria for initiating a trial of spontaneous respiration (P <.001). Seven patients simultaneously met both criteria for maintaining total spontaneous ventilation and the remaining five patients met conventional criteria before intermittent mandatory ventilation criteria. In the latter group, the pHa decreased below 7.35 during spontaneous respiration but in only one patient did it fall below 7.30. Our findings suggest that a patient's ability to maintain a pHa of greater than 7.35 while decreasing the frequency of mechanical ventilator breaths is more accurate than peak negative pressure and vital capacity for predicting ability to sustain adequate spontaneous respiration.
(Arch Surg 113:1441-1443, 1978)
Author Affiliations
USN
From the Department of Anesthesiology, US Naval Regional Medical Center, San Diego (Dr Millbern); and the Departments of Anesthesiology (Drs Downs, Modell,and Ms Jumper) and Surgery (Dr Downs), University of Florida College of Medicine, Gainesville.
Footnotes
Accepted for publication March 26, 1978.
Presented in part at the annual meeting of the American Society of Anesthesiologists, New Orleans, Oct 17, 1977.
The opinions or assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy.
Reprint requests to the Department of Anesthesiology, University of Florida College of Medicine, Box J-254, J. Hillis Miller Health Center, Gainesville, FL 32610 (Dr Downs).
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