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Related Experiment Videos

Provision of long-term mechanical ventilation

D J Scheinhorn1, M Stearn-Hassenpflug

  • 1Barlow Respiratory Hospital, Los Angeles, California, USA. djs@barlow2000.org

Critical Care Clinics
|January 19, 1999
PubMed
Summary

This review covers key decisions for prolonged mechanical ventilation, including tracheostomy timing and post-intensive care unit (ICU) transfer. It also addresses decannulation and home ventilation strategies for better patient outcomes.

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Area of Science:

  • Critical Care Medicine
  • Pulmonary Medicine
  • Respiratory Therapy

Background:

  • Prolonged mechanical ventilation presents complex management challenges for physicians.
  • Decisions span intensive care unit (ICU) care through various post-ICU settings.
  • Optimizing patient care requires strategic planning for ventilation weaning and support.

Purpose of the Study:

  • To review current evidence and expert consensus on tracheostomy procedures.
  • To guide decisions regarding patient transfer from the ICU for weaning or ongoing support.
  • To discuss strategies for successful decannulation and home ventilation.

Main Methods:

  • Literature review of current thinking and outcome data.
  • Synthesis of evidence on tracheostomy timing, technique, and outcomes.
  • Analysis of transfer criteria and post-ICU care models.
  • Review of decannulation protocols and home ventilation management.

Main Results:

  • Tracheostomy timing and technique impact patient outcomes and resource utilization.
  • Appropriate patient selection and transfer to lower-acuity settings facilitate weaning.
  • Successful decannulation requires careful assessment and multidisciplinary coordination.
  • Home ventilation can be a safe and effective option for select patients.

Conclusions:

  • Strategic decision-making regarding tracheostomy, transfer, and decannulation is crucial for patients requiring prolonged mechanical ventilation.
  • Evidence-based guidelines can optimize care pathways and improve patient outcomes.
  • Multidisciplinary collaboration is essential for managing patients through the continuum of care.

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