Lisa A. Duffner

Effect of Pressure Support vs Unassisted Breathing Through a Tracheostomy Collar on Weaning Duration in Patients Requiring Prolonged Mechanical Ventilation: A Randomized Trial

PATIENTS REQUIRING PROLONGED mechanicalventilation,defined asmore than21days, account for more than 13% of ventilated patients and 37% of intensive care unit (ICU) costs. Because of changes in US reimbursement practices, these patients areusuallytransferredtocentersthatspecialize in weaning, also known as longterm acute care hospitals (LTACHs). The number of LTACHs increased from 192to408between1997and2006, and costs increased by 267%, reaching

Depressive disorders during weaning from prolonged mechanical ventilation

1.3 billion in 2006. With aging of the US population, demand for intensivist services is predicted to increase by 38% over the next decade. Consequently, the number of ICU patients transferred to LTACHs for weaning from prolonged ventilation is expected to increase substantially. In studies of ICU patients, randomized trials have revealed that ventilator duration was influenced by weaning methods. The 2 most common weaning methods are pressure support and spontaneous breathing trials. The relative efficacy of these methods has undergone little or no scrutiny in patients receiving care at LTCAHs. Accordingly, we performed a randomized study in patients transferred to an LTACH for weaning from prolonged ventilation to compare the length of time required for weaning Author Affiliations are listed at the end of this article. Corresponding Author: Amal Jubran, MD, Division of Pulmonary and Critical Care Medicine, Edward Hines Jr VA Hospital, 111N, 5000 Fifth Ave, Hines, IL 60141 (mtobin2@lumc.edu). Caring for the Critically Ill Patient Section Editor: Derek C. Angus, MD, MPH, Contributing Editor, JAMA (angusdc@upmc.edu). Importance Patients requiring prolonged mechanical ventilation (!21 days) are commonly weaned at long-term acute care hospitals (LTACHs). The most effective method of weaning such patients has not been investigated.