2022 Year in Review: Ventilator Liberation

Abstract

Mechanical ventilation is ubiquitous in critical care, and duration of ventilator liberation is variable and multifactorial. While ICU survival has increased over the last two decades, positive-pressure ventilation can cause harm to patients. Weaning and discontinuation of ventilatory support is the first step in ventilator liberation. Clinicians have a wealth of evidence-based literature at their disposal; however, more high-quality research is needed to describe outcomes. Additionally, this knowledge must be distilled into evidence-based practice and applied at the bedside. A proliferation of research on the subject of ventilator liberation has been published in the last 12 months. Whereas some authors have reconsidered the value of applying the rapid shallow breathing index in weaning protocols, others have begun to investigate new indices to predict liberation outcomes. New tools such as diaphragmatic ultrasonography have begun to appear in the literature as a tool for outcome prediction. A number of systematic reviews with both meta-analysis and network meta-analysis that synthesize the literature on ventilator liberation have also been published in the last year. This review describes changes in performance, monitoring of spontaneous breathing trials, and evaluations of successful ventilator liberation.

Keywords: airway extubation; lung ultrasound; noninvasive ventilation; rapid shallow breathing index; ventilator liberation; ventilator weaning.

Fig. 1.

Receiver operating characteristic curve of diaphragmatic electromyography indices and ultrasound measurements plus RSBI for prediction of liberation outcome. RSBI = rapid shallow breathing index; DE = diaphragmatic excursion; DTF = diaphragm thickening fraction; EAdi = electrical activity of the diaphragm; NVE = neuroventilatory efficiency. From Reference 22.