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(Chest. 2001;120:438S-444S.)
© 2001 American College of Chest Physicians

Trials of Miscellaneous Interventions to Wean From Mechanical Ventilation*

Deborah Cook, MD; Maureen Meade, MD; Gordon Guyatt, MD; Ron Butler, MD; Aziz Aldawood, MD and Scott Epstein, MD

* From the Department of Medicine (Drs. Cook, Meade, Guyatt, and Aldawood), McMaster University, Hamilton, Ontario, Canada; the Department of Anesthesia (Dr. Butler), University of Western Ontario, London, Ontario, Canada; and the Department of Medicine (Dr. Epstein), New England Medical Center, Tufts University, Boston, MA.

Correspondence to: Deborah J. Cook, MD, McMaster University, Faculty of Health Sciences Center, Department of Clinical Epidemiology & Biostatistics, 1200 Main St West, Hamilton, Ontario, Canada; e-mail: debcook{at}mcmaster.ca

We found eight randomized controlled trials (RCTs) of miscellaneous interventions that were designed to facilitate the process of weaning from mechanical ventilation. The two RCTs of high-fat/low-carbohydrate enteral nutrition found favorable physiologic effects on CO2 production and respiratory quotient, rendering this type of nutrition potentially useful in patients with impaired ventilatory reserve; however, no conclusions can be made about the outcomes of the duration of ventilation and weaning success. The two RCTs of postextubation use of noninvasive ventilation are conflicting, showing potential short-term physiologic benefit in one study, but no benefit in terms of reintubation rates or other morbidity. These RCTs are less promising than other applications of noninvasive ventilation such as those in patients with COPD exacerbations. One RCT showed no improvement in success of weaning with exogenous growth hormone administration. In the setting of very frequent baseline blood gas analyses, one RCT of oximetry and capnography was associated with significantly fewer blood gas analyses. Biofeedback to enhance safe and rapid weaning showed a dramatically lower duration of ventilation in one RCT that did not report the weaning methods used. One RCT of preextubation acupuncture showed lower rates of laryngospasm in the acupuncture group. Overall, these studies were underpowered for clinically important outcomes. Multidisciplinary, patient-centered, holistic, and non-pulmonary approaches to weaning may provide additional safe, effective adjunctive methods of hastening liberation from mechanical ventilation.

Key Words: acupuncture • biofeedback • capnography • enteral nutrition • growth hormone • mechanical ventilation • meta-analysis • noninvasive ventilation • oximetry • systematic reviews • weaning






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Copyright © 2001 by the American College of Chest Physicians.