This is the podcast surgery. I see rounds. I'm Jeff Guy. Today I want to talk about weaning from

mechanical ventilation or properly, or some more proper as liberating people from mechanical ventilators.

There was a study done in Europe some years ago that it showed that 50%, 50% of people who inadvertently

self-extibated, only 50% of them required reinitabation.

When you first look at a study like that, you think, gee, when I'm called to the bedside

of somebody who extubates, I should really pause prior to re-inobating them, and that would be

accurate. But the other side of that statistic is that about half of those patients, 50%, didn't

need to be ventilated the day that they self-extibated,

which is an alarming statistic that half the patients are on ventilators don't need to be there.

Certainly not on the mechanical ventilator.

When we think about respiratory failure mechanical ventilators, they're really a center stone of any modern surgical intensive care

unit. Patients with traumatic brain injuries, recovering from surgery, ARDS, from sepsis, pneumonia.

In fact, the lung is the most, the lung is the organ most commonly affected with organ dysfunctional organ

failure in a modern intensive care unit.

In the traditional sense, weaning from a mechanical ventilator, term, which I'm not very fond of,

really is defined as the process of abruptly or gradually withdrawing the mechanical ventilator.

An editorial came out in New England Journal of Medicine several years ago,

and it suggested that we remove that term weaning from mechanical ventilator

and instead use the word liberate from the mechanical ventilator.

And that editorial came out and basically said or implied

that our methods of removing patients from the ventilator were essentially inappropriately.

Two large multi-centered trials, along by Esteban, published in the English Journal of Medicine

...