Monday April 10, 2006
Prolonged Mechanical Ventilation - Consensus statement of National Association for Medical Direction of Respiratory Care (NAMDRC)
In May 2004, NAMDRC (chair - Neil R. MacIntyre, MD), a physician advocacy organization for excellence in the delivery of respiratory and critical care, made 12 recommendations for patients with Prolonged Mechanical Ventilation (PMV). We are putting only few salient features here. Full article can be obtained from reference.
1. PMV should be defined as the need for more than / = 21 consecutive days of mechanical ventilation for more than / = 6 h/day.
2. In patients with slowly resolving respiratory insufficiency, complete liberation from mechanical ventilation (or a requirement for only nocturnal NIV) for 7 consecutive days should constitute successful weaning.
3. Greatest emphasis should be placed on identifying factors that are potentially reversible, especially iatrogenic factors.
4. All facilities that are available to patients should be screened by the critical care team for effectiveness and safety when effecting discharge for post-ICU weaning.
5. Begin considerations for PMV-focused care when tracheostomy is first considered.
6. PMV weaning strategies should thus incorporate nonphysician-implemented weaning protocols that utilize daily SBTs of progressively increasing duration after a certain level of ventilatory support reduction has occurred.
Reference:
Management of Patients Requiring Prolonged Mechanical Ventilation - Report of a NAMDRC Consensus Conference - Chest. 2005;128:3937-3954.
