DIRECT EXTUBATION VERSUS PRESSURE SUPPORT AND/ OR SYNCHRONIZED INTERMITTENT MANDATORY VENTILATION IN MECHANICALLY VENTILATED PATIENTS FULFILLING WEANING CRITERIA

Abstract

lthough, in hincipal, weaning simply entails the withdrawal of a\ryatient from a mechanical ventilator, in practice not only it is \'\ critical and potentially dangerous transition period for the pb.\ nt but also the method by which it is accomplished presen1.\\ an unusually charged and \ controversial issue among crih>al care practitioners. Despite of the severcil' techniques that had been developed in the last few years to facilitate discontinuation of MV, weaning remains a great challenge for the physician, possibly, more than the patient. Various physiological criteria are commonly used to help in predicting if weaning will be successful. These criteria should be applied in the context of an overall assessment of the patient's clinical condition by the experienced personnel and with recognition that trends of parameters are often more predictive of outcome than is a single value. These are not rigid rules to follow and don't substitute the experienced clinical sense and so Browne(1984) and Milic-Emili (1986) largely consider weaning to be an art as well as a science. The present study was conducted on 30 patients admitted to the intensive care"Jwith ARF and requiring MV. They were divided into two groups: 15 patients were randomly weaned by the direct extubation while the other 15 patients were weaned by PSV/SIMV. All patients were investigated and monitored during the ventilation and weaning periods. The aim of this thesis was to evaluate the influence of either method on weaning outcome as well as to detect the