S2k-Guideline “Prolonged Weaning”

Abstract All mechanically ventilated patients must be weaned from the ventilator at some stage. According to an International Consensus Conference the criteria for “prolonged weaning” are fulfilled if patients fail at least 3 weaning attempts (i. e. spontaneous breathing trial, SBT) or require more than 7 days of weaning after the first SBT. This occurs in about 15 – 20 % of patients. Because of the growing number of patients requiring prolonged weaning a German guideline on prolonged weaning has been developed. It is an initiative of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., DGP) in cooperation with other societies (see acknowledgement) engaged in the field chaired by the Association of Scientific and Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). This guideline deals with the definition, epidemiology, weaning categories, underlying pathophysiology, therapeutic strategies, the weaning unit, transition to out-of-hospital ventilation and therapeutic recommendations for end of life care. This short version summarises recommendations on prolonged weaning from the German guideline.

[1]  S. McClave,et al.  Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). , 2009, JPEN. Journal of parenteral and enteral nutrition.

[2]  S. McClave,et al.  Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) , 2009, Critical care medicine.

[3]  H. Sitter,et al.  S2k-Guideline “Prolonged Weaning” , 2015, Pneumologie.

[4]  H. Sitter,et al.  Prolonged Weaning: S2k Guideline Published by the German Respiratory Society , 2020, Respiration.

[5]  Duncan Young,et al.  Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. , 2013, JAMA.

[6]  W. Randerath,et al.  [Recommendations for invasive home mechanical ventilation]. , 2011, Pneumologie.

[7]  K. Rimmer,et al.  Home mechanical ventilation: a Canadian Thoracic Society clinical practice guideline. , 2011, Canadian respiratory journal.

[8]  Nicola A. Maffiuletti,et al.  Physiological and methodological considerations for the use of neuromuscular electrical stimulation , 2010, European Journal of Applied Physiology.

[9]  H. Sitter,et al.  Non-Invasive and Invasive Mechanical Ventilation for Treatment of Chronic Respiratory Failure S 2-Guidelines Published by The German Medical Association of Pneumology and Ventilatory Support , 2010 .

[10]  S. Nava,et al.  Delirium in patients admitted to a step-down unit: analysis of incidence and risk factors. , 2010, Journal of critical care.

[11]  Daren K. Heyland,et al.  Nutrition therapy in the critical care setting: What is “best achievable” practice? An international multicenter observational study* , 2010, Critical care medicine.

[12]  Christina Routsi,et al.  Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study , 2009, Critical care.

[13]  O. Burghuber,et al.  Incidence and outcome of weaning from mechanical ventilation according to new categories , 2009, European Respiratory Journal.

[14]  P. Beuret,et al.  Interest of an objective evaluation of cough during weaning from mechanical ventilation , 2009, Intensive Care Medicine.

[15]  T. Similowski,et al.  Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients , 2008, Intensive Care Medicine.

[16]  Stefano Nava,et al.  Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients , 2008, Intensive Care Medicine.

[17]  F. Herth,et al.  [Weaning from mechanical ventilation. A survey of the situation in pneumologic respiratory facilities in Germany]. , 2008, Deutsche Medizinische Wochenschrift.

[18]  P. Haidl,et al.  Tracheostomy decannulation: Implication on respiratory mechanics , 2007, Head & neck.

[19]  Lorenzo Berra,et al.  Outcome of patients undergoing prolonged mechanical ventilation after critical illness* , 2007, Critical care medicine.

[20]  A. Simonds,et al.  End-of-life decision-making in respiratory intermediate care units: a European survey , 2007, European Respiratory Journal.

[21]  K. Higgins,et al.  Meta‐Analysis Comparison of Open Versus Percutaneous Tracheostomy , 2007, The Laryngoscope.

[22]  T. Vassilakopoulos,et al.  Ventilator-induced diaphragm dysfunction: the clinical relevance of animal models , 2007, Intensive Care Medicine.

[23]  L. Fabbri,et al.  Intrapulmonary percussive ventilation in tracheostomized patients: a randomized controlled trial , 2006, Intensive Care Medicine.

[24]  Robert W. Taylor,et al.  Red blood cell transfusions and nosocomial infections in critically ill patients* , 2006, Critical care medicine.

[25]  Y. Wu,et al.  Effects of Physical Training on Functional Status in Patients With Prolonged Mechanical Ventilation , 2006, Physical Therapy.

[26]  S. Nava,et al.  Physiological responses during a T-piece weaning trial with a deflated tube , 2006, Intensive Care Medicine.

[27]  S. Bagshaw,et al.  Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis , 2006, Critical care.

[28]  M. Bailey,et al.  Outcomes, cost and long term survival of patients referred to a regional weaning centre , 2005, Thorax.

[29]  S. Nava,et al.  Respiratory response and inspiratory effort during pressure support ventilation in COPD patients , 1995, Intensive Care Medicine.

[30]  F. Lemaire,et al.  Principles and practice of mechanical ventilation , 1995, Intensive Care Medicine.

[31]  P. Hazard,et al.  A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients* , 2004, Critical care medicine.

[32]  S. Gilbertson-White,et al.  Documentation on withdrawal of life support in adult patients in the intensive care unit. , 2004, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[33]  J. Rozich,et al.  Shifting care of chronic ventilator-dependent patients from the intensive care unit to the nursing home. , 2004, Joint Commission journal on quality and safety.

[34]  C. Rand,et al.  A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation. , 2004, American journal of respiratory and critical care medicine.

[35]  M. Elliott.  Non-invasive ventilation for acute respiratory disease. , 2004, British medical bulletin.

[36]  Joseph Varon,et al.  Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. , 2003, The New England journal of medicine.

[37]  G. Postma,et al.  Fiberoptic Endoscopic Evaluation of Swallowing , 2003, The Laryngoscope.

[38]  S. Parthasarathy,et al.  Is weaning failure caused by low-frequency fatigue of the diaphragm? , 2003, American journal of respiratory and critical care medicine.

[39]  P. Holland,et al.  Noninfectious serious hazards of transfusion. , 2002, Current hematology reports.

[40]  J. Vincent,et al.  The cuff leak test to predict failure of tracheal extubation for laryngeal edema , 2002, Intensive Care Medicine.

[41]  S. Nava,et al.  Survival of mechanically ventilated patients admitted to a specialised weaning centre , 2002, Intensive Care Medicine.

[42]  D. Garland,et al.  Heterotopic Ossification Complicating Prolonged Intubation: Case Report And Review Of The Literature , 2002, The journal of spinal cord medicine.

[43]  S. Jaber,et al.  Post-extubation stridor in intensive care unit patients , 2002, Intensive Care Medicine.

[44]  P. Kumar,et al.  Tracheoesophageal fistula and massive pneumoperitoneum after prolonged mechanical ventilation. , 2001, Southern medical journal.

[45]  M. Elliott,et al.  Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome , 2001, Thorax.

[46]  T. Gilmer,et al.  Impact of ethics consultations in the intensive care setting: A randomized, controlled trial , 2000, Critical care medicine.

[47]  T. Perneger,et al.  Percutaneous or surgical tracheostomy: a meta-analysis. , 1999, Critical care medicine.

[48]  P. Haidl,et al.  Scintigraphy for evaluating early aspiration after oral feeding in patients receiving prolonged ventilation via tracheostomy , 1999, Intensive Care Medicine.

[49]  G. Wells,et al.  A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. , 1999, The New England journal of medicine.

[50]  M. Campbell,et al.  Patient responses during rapid terminal weaning from mechanical ventilation: a prospective study. , 1999, Critical care medicine.

[51]  H. Böhrer,et al.  Blood transfusion facilitating difficult weaning from the ventilator , 1998, Anaesthesia.

[52]  F. Gordo,et al.  Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. , 1997, American journal of respiratory and critical care medicine.

[53]  M J Tobin,et al.  Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. , 1997, American journal of respiratory and critical care medicine.

[54]  J. Fitting,et al.  Regulation of Inspiratory Neuromuscular Output during Synchronized Intermittent Mechanical Ventilation , 1994, Anesthesiology.

[55]  S. Chevret,et al.  Influence of long‐term oro‐ or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: Results of a prospective, randomized, clinical trial , 1993, Critical care medicine.

[56]  M. Tobin,et al.  A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. , 1992, The New England journal of medicine.

[57]  W. Sanborn.  Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. , 1989, The American review of respiratory disease.

[58]  I. Grossbach-Landis,et al.  Weaning from mechanical ventilation , 2005, ERS practical Handbook of Invasive Mechanical Ventilation.

[59]  U Nordin,et al.  The trachea and cuff-induced tracheal injury. An experimental study on causative factors and prevention. , 1977, Acta oto-laryngologica. Supplementum.