Question

According to Schreiber et al 2019, in a stepwise approach to early mobility what level would a patient have to reach to most successfully wean from prolonged mechanical ventilation?

Answer 1

Patients undergoing prolonged mechanical ventilation represent up to 15% of all patients requiring weaning from mechanical ventilation. Although recent guidelines have recommended including physiotherapy early during mechanical ventilation to speed the process of weaning, only indirect evidence supporting the use of physiotherapy is available for patients receiving prolonged mechanical ventilation. The aim of our study was to evaluate the effects of a physiotherapy program in subjects requiring prolonged mechanical ventilation and the correlates of successful weaning.Weaning, the process of withdrawing mechanical ventilation, begins as soon as the pathology leading to intubation is considered sufficiently controlled to allow a return to spontaneous breathing.Weaning accounts for up to 50% of the total duration of mechanical ventilation. Up to 80% of patients admitted to an ICU can be successfully weaned in the first attempt, whereas a smaller proportion fail the first spontaneous breathing trial. These categories have been previously defined as simple, difficult, and prolonged weaning, respectively. After patients are clinically stable, those who require prolonged mechanical ventilation can be transferred to a weaning unit, a step-down unit, or a long-term facility. These units have a weaning success rate of up to 60% for patients with prolonged mechanical ventilation.