Original Article
A Prospective Study of Indexes Predicting the Outcome of Trials of Weaning from Mechanical Ventilation
N Engl J Med 1991; 324:1445-1450May 23, 1991
- Abstract
- Abstract
Background.
The traditional predictors of the outcome of weaning from mechanical ventilation — minute ventilation (VE) and maximal inspiratory pressure (P1max) — are frequently inaccurate. We developed two new indexes: the first quantitates rapid shallow breathing as the ratio of respiratory frequency to tidal volume (f/VT), and the second is termed CROP, because it integrates thoracic c̱ompliance, respiratory
ate, arterial o̱xygenation, and P1max.
Methods.
The threshold values for each index that discriminated best between a successful and an unsuccessful outcome of weaning were determined in 36 patients, and the predictive accuracy of these values was then tested prospectively in an additional 64 patients. Sensitivity and specificity were calculated, and the data were also analyzed with receiver-operating-characteristic (ROC) curves, in which the proportions of true positive results and false positive results are plotted against each other for a number of threshold values of an index; the area under the curve reflects the accuracy of the index.
Results.
Sensitivity was highest for P1max (1.00), followed closely by the f/VT ratio (0.97). Specificity was highest for the f/VT ratio (0.64) and lowest for P1max (0.11). The f/VT ratio was the best predictor of successful weaning, and P1max and the f/VT ratio were the best predictors of failure. The area under the ROC curve for the f/VT ratio (0.89) was larger than that under the curves for the CROP index (0.78, P<0.05), P1max (0.61, P<0.001), and VE (0.40, P<0.001).
Conclusions.
Rapid shallow breathing, as reflected by the f/VT ratio, was the most accurate predictor of failure, and its absence the most accurate predictor of success, in weaning patients from mechanical ventilation. (N Engl J Med 1991;324:1445–50.)
Article Activity
- Article
ALTHOUGH an experienced physician may be able to foretell the likely outcome of trying to wean a patient from mechanical ventilation, it is desirable to have predictive indexes that can be easily measured and widely applied. The purposes of such indexes are to identify the earliest time that a patient can resume spontaneous breathing and to identify patients in whom a trial of weaning is likely to fail, so that cardiorespiratory distress or collapse can be avoided. In addition, such indexes assess many different physiologic functions and may provide insight into the reasons for dependence on a ventilator.1
A number of indexes, such as vital capacity,2 maximal inspiratory pressure (PImax),2 , 3 and minute ventilation (VE),3 4 5 have been proposed as accurate predictors of the outcome of weaning, but in recent studies their predictive power has been very poor.6 7 8 9 The discrepancy in results between the original study and more recent ones may be due to several factors, including differences in patient populations3 , 6 , 8 or in techniques of measurement,10 and the lack of objective criteria to define weaning outcome. Another reason why a predictive index may perform poorly is that it does not accurately reflect the true pathophysiologic determinants of the outcome of weaning.
Since many factors can be responsible for the failure of an attempt to wean a patient from mechanical ventilation, we reasoned that accurate prediction is more likely with an index that integrates a number of physiologic functions.11 We developed two new indexes. The first is the ratio of respiratory frequency (f) to tidal volume (VT), which quantitates the extent of rapid shallow breathing — a common finding in patients in whom a weaning trial fails.12 The second index incorporates a measure of pulmonary gas exchange and an assessment of the relation between the demands placed on the respiratory system and the capacity of the respiratory muscles to handle them. We compared these new indexes with traditional ones with regard to accuracy. The study was divided into two parts: first, the threshold values of the indexes that discriminated best between successful weaning and weaning failure were determined; second, the accuracy of each index was assessed prospectively in an additional group of patients. The accuracy of the various indexes was also assessed with receiver-operating-characteristic (ROC) curves.13 , 14
Methods
Patients
One hundred patients (46 men and 54 women; mean age [±SE], 59.6± 1.7 years) who were clinically stable and whose primary physicians considered them ready to undergo a weaning trial were recruited from our medical intensive care units. The patients had received 8.2 ± 1.1 days of ventilator support. Their physicians were blinded to the study design and the measurements obtained, although arterial blood gas values and routine measurements by respiratory therapists (PImax, thoracic compliance, and VE and its subdivisions) were available to them. The decision to extubate a patient or reinstitute mechanical ventilation was made solely by the primary physician. The study was approved by the institutional ethics committee of the University of Texas Health Science Center.
Index of Rapid Shallow Breathing
While each patient breathed spontaneously for one minute, rapid shallow breathing was quantitated as the respiratory frequency (the number of breaths per minute) divided by the VT in liters.
Integrative Index
The fraction of maximal inspiratory muscle strength used in each breath, or what may be termed the fraction of the inspiratory-effort reserve — i.e., the ratio of mean inspiratory pressure (PI) to PImax — is an important determinant of respiratory-muscle fatigue15 and can be calculated as follows:
(1) Fraction of inspiratory-effort reserve per breath = PI/PImax.
For a given VT, PI is inversely proportional to the "dynamic compliance" of the respiratory system (Cdyn ).16 Thus, equation 1 can be expressed as follows:
(2) Fraction of inspiratory-effort reserve per breath α (1/Cdyn)/PImax.
Likewise, an index of the rate of energy expenditure per minute can be obtained by multiplying equation 2 by the respiratory rate (the number of breaths per minute):
(3) Rate of energy expenditure per minute α rate/(Cdyn X PImax).
For convenience, the elements of equation 3 can be inverted so that a high value indicates that respiratory demands are well matched by respiratory-muscle strength. A measure of gas exchange — specifically, the ratio of arterial to alveolar oxygen tension (Pa02/PA02)17 — is also incorporated, because in some patients a weaning trial fails because of impaired oxygenation rather than ventilatory-pump failure. The final form of the equation is
(4) Integrative index = (Cdyn x PImax X [Pa02/ PAO2)/rate,
which we have termed the CROP index, an acronym for compliance, rate, oxygenation, and pressure.
Data Collection
During mechanical ventilation, the delivered volume was measured at the endotracheal tube with a calibrated spirometer (Boehringer Laboratory, Wynnewood, Pa.). Airway pressure was measured with a differential pressure transducer (model 78905A, Hewlett-Packard, Waltham, Mass.) attached to the endotracheal tube. The inflationary pressure needed to overcome the elastic recoil of the respiratory system was measured as the plateau in airway pressure that resulted from temporary occlusion of the expiratory tubing at end-inspiration.18 The patient's airway was also occluded at end-expiration to detect the presence of spontaneous positive end-expiratory pressure.19 The "static compliance" (Cst) of the respiratory system was calculated as volume delivered/(plateau pressure — positive end-expiratory pressure),18 and the "dynamic compliance" (Cdyn) as volume delivered/(peak airway pressure — positive end-expiratory pressure).18
PImax was measured with a calibrated differential pressure transducer. A unidirectional valve was attached to the airway, permitting expiration but not inspiration, and the most negative pressure recorded during 20 seconds of airway occlusion was taken as the PImax.10 After the discontinuation of mechanical ventilation, the patient breathed room air spontaneously for one minute, while VE and f were measured with a spirometer; the spontaneous VT was calculated by dividing VE by f. Both the VT corrected for the patient's weight (VT/weight in kilograms) and the uncorrected value were used in the data analysis. A sample of arterial blood was collected for blood gas analysis while the patient was receiving mechanical ventilation, and pulmonary gas exchange was assessed by calculation of the Pa02/PA02 ratio.17
Classification of Weaning Outcomes
The group that was successfully weaned consisted of 60 patients who were able to sustain spontaneous breathing for ≥24 hours after extubation.7 , 9 , 20 The group in which weaning failed consisted of 40 patients in whom mechanical ventilation was reinstituted at the end of a weaning trial or who required reintubation within 24 hours. The patients in whom weaning failed were divided into two subgroups on the basis of their arterial blood gas values at the end of the trial.3 , 12 , 20 , 21 Twenty-eight patients met objective criteria for weaning failure because they had one or more of the following: a partial pressure of carbon dioxide ≥50 torr (7 kPa) (17 patients), an increase in partial pressure of carbon dioxide of ≥8 torr (1 kPa) (18 patients), a pH of arterial blood ≤7.33 (16 patients), a decrease in pH of ≥0.07 (19 patients), or a partial pressure of oxygen ≤60 torr (8 kPa) with a fraction of inspired oxygen ≥0.5 (5 patients). The remaining 12 patients met subjective criteria for weaning failure because diaphoresis, evidence of increasing effort, tachycardia, arrhythmias, or hypotension required the reinstitution of mechanical ventilation.
Study Design
The patients were assigned to one of two data sets, depending on the order in which they entered the study. The "training set" consisted of the first 36 patients who were successfully weaned (24 patients) or in whom weaning failed according to objective criteria (12 patients). Data on these patients were used to determine which value for each index studied best differentiated the patients who were successfully weaned from those in whom weaning failed. The value selected as the threshold value was the one that resulted in the fewest false classifications. This decision was based on the assumption that the disadvantages associated with either a false positive result or a false negative result were equal, since weaning trials undertaken either prematurely or after an unnecessary delay were considered equally deleterious to a patient's health.
The predictive power of the threshold value for each index was assessed in the remaining 64 patients, who constituted the "prospective-validation set." The data for this group were subdivided in two ways —first, to compare the 36 patients who were successfully weaned with the 28 patients in whom weaning failed, and second, to compare the 36 successfully weaned patients with the 16 patients who met objective criteria for weaning failure. The clinical diagnoses of the patients in the training and the prospective-validation sets were as follows: adult respiratory distress syndrome (in 10 and 18 patients, respectively), pneumonia (9 and 9 patients), obstructive airway disease (6 and 11), central nervous system disorders (6 and 7), congestive heart failure (2 and 12), pulmonary fibrosis (0 and 2), and miscellaneous other diagnoses (3 and 5).
Statistical Analysis
A true positive result was defined as occurring when a patient's test predicted weaning success and weaning actually succeeded, a true negative result as occurring when a test predicted weaning failure and weaning actually failed, a false positive result as occurring when a test predicted weaning success but weaning failed, and a false negative result as occurring when a test predicted weaning failure but weaning succeeded. Standard formulas were used to calculate the sensitivity (true positives/[true positives + false negatives]), specificity (true negatives/[true negatives + false positives]), positive predictive value (true positives/[true positives + false positives]), and negative predictive value (true negatives/[true negatives + false negatives]) of each index.22
The predictive performance of each index was also assessed with ROC curves. ROC-curve analysis provides a powerful means of assessing a test's ability to discriminate between two groups of patients, with the advantage that the analysis does not depend on the threshold value selected.13 , 14 , 23 The area under the ROC curve for each index, which summarizes the performance of that index in predicting weaning outcome, was calculated by the nonparametric method of Hanley and McNeil24; the technique developed by these authors was also used to compare the areas under the curves. Two sets of ROC curves were constructed for the prospective-validation data set. The first set was derived from the data on the 36 successfully weaned patients and all 28 patients in whom weaning failed, and the second set was derived from the data on the 36 successfully weaned patients and the 16 patients who met objective criteria for weaning failure.
Results
The threshold values for each index that discriminated best in the training set of data between the successfully weaned patients and the patients in whom weaning failed are shown in Table 1Table 1
Threshold Values of Indexes Used to Predict Weaning Outcome..The accuracy of each index in the prospective-validation data set is shown in Table 2Table 2
Accuracy of the Indexes Used to Predict Weaning Outcome.*. Sensitivity was 1.00 for PImax, which was marginally higher than the sensitivity of the f/VT ratio or the VT (both of which were 0.97). Specificity was highest for the f/VT ratio (0.64) and lowest for PImax (0.11). Positive predictive value was highest for the f/VT ratio (0.78). Negative predictive value was highest for the PImax (1.00), followed closely by the f/VT ratio (0.95).Besides examining the accuracy of the predictive indexes in the successful-weaning group and the group of all patients in whom weaning failed, we also examined the indexes' accuracy in discriminating between the successfully weaned patients and the patients who met objective criteria for weaning failure. In this second comparison, the specificities and positive predictive values of Cdyn, Cst, the Pa02/PA02 ratio, and the CROP index were considerably higher (by ≥0.15), but no major differences were observed in sensitivity and negative predictive value.
We assessed the influence of the duration of mechanical ventilation on the accuracy of the predictive indexes by comparing the patients who required mechanical ventilation for ≥8 days with those who required it for shorter periods (Table 3Table 3
Effect of Duration of Mechanical Ventilation (<8 Days or ≥8 Days) on the Accuracy of Indexes in Predicting Weaning Outcome.*). The accuracy was generally lower (by ≥0.15) in the patients requiring ≥8 days of mechanical ventilation, especially in terms of positive predictive value; the differences in sensitivity, specificity, and negative predictive value were smaller. The specificity of PImax and the negative predictive values of f and the Pa02/PA02 ratio were higher, however, in the patients requiring ≥8 days of ventilatory support.Figure 1Figure 1
Isopleths for the Ratio of Breathing Frequency to Tidal Volume, Representing Different Degrees of Rapid Shallow Breathing. shows a series of isopleths for the f/VT ratio that represent different degrees of rapid shallow breathing. The points to the left of the isopleth representing 100 breaths per minute per liter indicate patients with a 95 percent likelihood that a weaning trial would fail, whereas the points to the right of this isopleth indicate patients with an 80 percent likelihood of successful weaning.The areas under the ROC curves for each index are shown in Table 4Table 4
Area under the ROC Curve for Each Index.*, and the curves of selected indexes are shown in Figure 2Figure 2
ROC Curves for the f/VT Ratio, CROP Index, PImax, and VE in the Prospective-Validation Data Set of 64 Patients.. For most indexes, the areas were significantly larger than that of an arbitrary test that is expected a priori to have no discriminatory value (i.e., 0.50), with the exception of the areas for VE (0.40), Pa02/PA02 (0.48), and PImax (0.61). In addition, the areas under the ROC curves for VE and PImax were significantly smaller than those for the CROP index (P<0.001 and P<0.03, respectively), the f/VT ratio (P<0.001 in both instances), VT (P<0.001 in both instances), or f (P<0.001 and P<0.03, respectively), whereas the area under the curve for VE was significantly smaller than those for Cdyn (P<0.003) and Cst (P<0.003). Except for the Pa02/PA02 ratio, which tended to decrease the diagnostic accuracy, the areas under the ROC curves tended to become larger as additional components were incorporated into the CROP index: for Cdyn, the area was 0.67±0.07; for compliance and oxygenation (Cdyn X Pa02/PA02), it was 0.58±0.07; for compliance and pressure (Cdyn X PImax), it was 0.73±0.06; for compliance and respiratory rate (Cdyn/rate), it was 0.80±0.06; for compliance, pressure, and rate together (Cdyn X PImax/rate), it was 0.82±0.05; and for the CROP index it was 0.78±0.06. The area under the ROC curve for compliance, pressure, and rate was significantly larger than those for Cdyn (P<0.03) and compliance and oxygenation (P<0.002), the area under the curve for compliance and rate was larger than those for Cdyn (P<0.03) and compliance and oxygenation (P<0.002), and the area under the curve for the CROP index was larger than that of compliance and oxygenation (P<0.01), but none of the other comparisons were significant. The area under the ROC curve for the f/VT ratio (0.89±0.05) was larger than that for the CROP index (0.78±0.06, P<0.05). The areas under the ROC curves generated by the data for the 36 successfully weaned patients and the 16 patients in whom weaning failed according to objective criteria were not significantly different from the areas generated by the data for the complete prospective-validation set of 64 patients.Discussion
The predictive power of each of the two new indexes of weaning outcome, the f/VT ratio and the CROP index, was considerably greater than that of traditional indexes, such as VE and PImax.
Certain aspects of study design become particularly important when an investigation of predictors of weaning outcome is undertaken, and also when such investigations are compared.1 , 25 First, the study population needs to be carefully defined. We limited our study population to medical patients, since it is generally more difficult to predict the weaning outcome in these patients than in surgical patients. Second, the technique of making the physiologic measurements needs to be clearly stated.10 , 18 Third, the end points of a study need to be well defined. The definition of successful weaning is fairly straightforward (successful spontaneous ventilation for ≥24 hours is the usual one), but that of weaning failure is more difficult. Almost all investigators have defined weaning failure on the basis of abnormal arterial blood gas measurements or clinical deterioration, without stating the relative proportion of each. The lack of objective criteria for weaning failure makes it difficult to compare the performance of predictive indexes in different studies, because the patients in whom a weaning trial was considered to have failed in one study might have been weaned successfully by a more aggressive physician. Accordingly, we analyzed separately the subgroup of patients who met objective criteria for weaning failure in addition to analyzing the entire group in whom weaning failed. Fourth, the method of choosing the threshold value for an index is critical. To our knowledge, all previous investigators have used post hoc analysis to determine the threshold values that discriminated best between successfully weaned patients and patients in whom weaning failed. In contrast, we determined the optimal threshold value for each index in the first 36 patients in our study (Table 1) and then tested the accuracy of these values prospectively in the remaining patients. Finally, we used an additional technique of data analysis, the construction of ROC curves, that circumvents the chief problem inherent in the technique of classic decision analysis — namely, dependence on the threshold value that is selected.
Sahn and Lakshminarayan3 reported that a PImax of ≤ — 30 cm of water ( — 3 kPa) invariably resulted in successful weaning and that a value of ≥ —20 cm of water ( — 2 kPa) invariably resulted in weaning failure; they also reported that a VE of ≥10 liters per minute was useful in predicting weaning failure. Subsequent investigators, however, found a high rate of false positive and false negative results when PImax6 , 7 , 9 , 26 or VE 6 , 8 , 9 was used as a criterion. Measures of the accuracy of these threshold values in our prospective-validation set are shown in Table 5Table 5
Accuracy of Various Threshold Values for the Indexes Used to Predict Weaning Outcome.*. The accuracy of indexes of pulmonary gas exchange18 as predictors of weaning outcome has never been subjected to detailed prospective investigation. In the prospective-validation data set, a Pa02/PA02 ratio of 0.35 was found to be a relatively weak predictor of weaning outcome (Table 2), which probably reflects the fact that abnormalities of oxygenation do not frequently determine weaning failure. Other indexes that have been used to predict weaning outcome include vital capacity and maximal voluntary ventilation,2 , 3 but these have also been reported to result in a high rate of false positive and false negative results6 , 27; in addition, their measurement requires considerable cooperation on the part of the patient, making reliable data more difficult to obtain.18 Weaning failure is commonly multifactorial in origin, and thus an index that assesses a single physiologic function may not be optimal.1 , 11 Indeed, this was borne out by the data in the present and previous studies, which showed that indexes assessing the major determinants of weaning outcome had limited diagnostic accuracy when used individually. In contrast, the CROP index, which assesses pulmonary gas exchange and the balance between respiratory demands and respiratory neuromuscular reserve, was a considerably more accurate predictor. The precise pathophysiologic basis of an elevated f/VT ratio in patients in whom a weaning trial fails is unknown,12 but we suspect that it is a stress response reflecting an imbalance between respiratory neuromuscular reserve and respiratory demands. As a predictor, the f/VT ratio has several attractive features: it is easy to measure, it is independent of the patient's effort and cooperation, it has high predictive power, and fortuitously, it has a "rounded-off" threshold value (100) that is easy to remember.
Of the primary indexes, VT was the most accurate in predicting weaning outcome. Since VT is determined by the interaction between the amount of inspiratory pressure generated for each breath and the load placed on the respiratory system (i.e., VT = PI X Cdyn), it is not too surprising that it proved to be a relatively accurate predictor. However, we are not aware of any previous study that has objectively evaluated its usefulness as a predictor of weaning outcome.
The areas under a number of the ROC curves in this study were quite large — specifically, 0.89, 0.87, and 0.77 for the f/VT ratio, VT, and the CROP index, respectively, which compare favorably with the areas under the ROC curves for diagnostic indexes that are considered reliable in everyday clinical practice. These include, for example, the ratio of forced expiratory volume in one second to forced vital capacity in the diagnosis of obstructive airways disease (0.86),28 mean corpuscular volume in the diagnosis of iron-deficiency anemia (0.79),13 and the acid phosphatase level in the diagnosis of prostatic carcinoma (0.75 to 0.80).13 In contrast, the areas under the ROC curves for PImax and VE (0.61 and 0.40, respectively) were not significantly larger than that of an arbitrary test that is expected a priori to have no discriminatory value (i.e., a value of 0.50).
In summary, the indexes traditionally used to predict weaning outcome had limited power and were considerably inferior to the f/VT ratio and the CROP index. The f/VT ratio, which quantitates rapid shallow breathing, appeared to be the single most accurate index, whereas the more complex CROP index, which reflects pulmonary gas exchange and the balance between respiratory demands and respiratory-muscle reserve, was slightly less accurate.
Supported in part by grants from the American Lung Association and the Veterans Affairs Research Service.
We are indebted to Drs. Robert Centor, Charles Metz, and Asha Kapadia for their advice on data analysis; to Drs. Robert F. Lodato, M. Jeffery Mador, and Amal Jubran for their careful review of the manuscript; and to Mr. Kevin Nelson for technical assistance.
Source Information
From the Division of Pulmonary and Critical Care Medicine, the University of Texas Health Science Center at Houston (K.L.Y.), and the Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, and the Loyola University of Chicago Stritch School of Medicine, Chicago (M.J.T.). Address reprint requests to Dr. Yang at the Division of Pulmonary and Critical Care Medicine, the University of Texas Health Science Center at Houston, 6431 Fannin, Suite 1.274, Houston, TX 77030.
- References
References
1
Tobin 2
Feeley
Full Text | Web of Science | Medline3
Sahn
CrossRef | Web of Science | Medline4
Stetson
CrossRef5
Pierson 6
Tahvanainen
CrossRef | Web of Science | Medline7
Fiastro
CrossRef | Web of Science | Medline8
Krieger
CrossRef | Web of Science | Medline9
Morganroth
CrossRef | Web of Science | Medline10
Marini
CrossRef11
Tobin
CrossRef | Web of Science | Medline12
Tobin
Web of Science | Medline13
Beck
Web of Science | MedlineErratum, Arch Pathol Lab Med 1986; 110:958.
Web of Science14
Metz
CrossRef | Web of Science | Medline15
Roussos
Web of Science | Medline16
Milic-Emili
Web of Science | Medline17
Gilbert
Web of Science | Medline18
Tobin
Web of Science | Medline19
Pepe
Web of Science | Medline20
Sassoon
Web of Science | Medline21
Swartz
CrossRef | Web of Science | Medline22
Griner
Web of Science23
Centor
CrossRef | Medline24
Hanley
Web of Science | Medline25
Wasson
Full Text | Web of Science | Medline26
DeHaven
CrossRef | Web of Science | Medline27
Milbern
Web of Science | Medline28
Beck
CrossRef
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Yusuf Alper Kilic, Ilke Kilic. (2010) A Novel Fuzzy Logic Inference System for Decision Support in Weaning from Mechanical Ventilation. Journal of Medical Systems 34:6, 1089-1095
CrossRef30
Yang Liu, Lu-Qing Wei, Guo-Qiang Li, Fu-Yun Lv, Huo Wang, Yu-Hua Zhang, Wen-Li Cao. (2010) A Decision-Tree Model for Predicting Extubation Outcome in Elderly Patients After a Successful Spontaneous Breathing Trial. Anesthesia & Analgesia 111:5, 1211-1218
CrossRef31
Lee K. Brown. (2010) Adaptive Servo-Ventilation for Sleep Apnea: Technology, Titration Protocols, and Treatment Efficacy. Sleep Medicine Clinics 5:3, 419-437
CrossRef32
Sangeeta Mehta, Matthew J. Heffer, Nava Maham, David L. Nelson, James R. Klinger, Mitchell M. Levy. (2010) Impact of endotracheal tube size on preextubation respiratory variables. Journal of Critical Care 25:3, 483-488
CrossRef33
Jose P. Garcia, Aldo Iacono, Zachary N. Kon, Bartley P. Griffith. (2010) Ambulatory extracorporeal membrane oxygenation: A new approach for bridge-to-lung transplantation. The Journal of Thoracic and Cardiovascular Surgery 139:6, e137-e139
CrossRef34
Leopoldo N. Segal, Erwin Oei, Beno W. Oppenheimer, Roberta M. Goldring, Rami T. Bustami, Salvatore Ruggiero, Kenneth I. Berger, Stanley B. Fiel. (2010) Evolution of pattern of breathing during a spontaneous breathing trial predicts successful extubation. Intensive Care Medicine 36:3, 487-495
CrossRef35
2010. Respiratory Management. , 383-436.
CrossRef36
J. Sellares, I. Acerbi, H. Loureiro, R. L. Dellaca, M. Ferrer, A. Torres, D. Navajas, R. Farre. (2009) Respiratory impedance during weaning from mechanical ventilation in a mixed population of critically ill patients. British Journal of Anaesthesia 103:6, 828-832
CrossRef37
Cheryl Crocker, Julie Scholes. (2009) The importance of knowing the patient in weaning from mechanical ventilation. Nursing in Critical Care 14:6, 289-296
CrossRef38
Laurent Brochard, Arnaud W. Thille. (2009) What is the proper approach to liberating the weak from mechanical ventilation?. Critical Care Medicine 37, S410-S415
CrossRef39
Sérgio N. Nemer, Carmen S.V. Barbas, Jefferson B. Caldeira, Bruno Guimarães, Leandro M. Azeredo, Ricardo Gago, Paulo Cesar P. Souza. (2009) Evaluation of maximal inspiratory pressure, tracheal airway occlusion pressure, and its ratio in the weaning outcome. Journal of Critical Care 24:3, 441-446
CrossRef40
Mehdi Chlif, David Keochkerian, Dominique Choquet, Agnes Vaidie, Said Ahmaidi. (2009) Effects of obesity on breathing pattern, ventilatory neural drive and mechanics. Respiratory Physiology & Neurobiology 168:3, 198-202
CrossRef41
Cheryl Crocker. (2009) Weaning from ventilation - current state of the science and art. Nursing in Critical Care 14:4, 185-190
CrossRef42
P. Sinha, N. J. Fauvel, S. Singh, N. Soni. (2009) Ventilatory ratio: a simple bedside measure of ventilation. British Journal of Anaesthesia 102:5, 692-697
CrossRef43
Brigitte Fauroux, Guillaume Aubertin, Annick Clément, Frédéric Lofaso, Monique Bonora. (2009) Which tests may predict the need for noninvasive ventilation in children with neuromuscular disease?. Respiratory Medicine 103:4, 574-581
CrossRef44
Samuel L. Krachman, Martin J. Tobin. 2009. Ventilator Support. , 705-712.
CrossRef45
Abraham Avi Nisim, Daniel R. Margulies, Matthew T. Wilson, Rodrigo F. Alban, Catherine M. Dang, Alexander D. Allins, M. Michael Shabot. (2008) A 2-minute pre-extubation protocol for ventilated intensive care unit patients. The American Journal of Surgery 196:6, 890-895
CrossRef46
Cassiano Teixeira, Paulo José Zimermann Teixeira, Jorge Amilton Hohër, Patrícia Pickersgill de Leon, Sérgio Fernando Monteiro Brodt, José da Siva Moreira. (2008) Serial measurements of f/VT can predict extubation failure in patients with f/VT ≤ 105?. Journal of Critical Care 23:4, 572-576
CrossRef47
Hsing-Lin Lin, Liang-Chi Kuo, Chao-Wen Chen, Yuan-Chia Cheng, Wei-Che Lee. (2008) Neck hyperflexion causing isolated thyroid cartilage fracture—a case report. The American Journal of Emergency Medicine 26:9, 1064.e1-1064.e3
CrossRef48
John Kellett. (2008) Prognostication — The lost skill of medicine. European Journal of Internal Medicine 19:3, 155-164
CrossRef49
Ghassan Jamaleddine, Mohamad El-Khatib. (2008) Pressure support ventilation: A significant confounding factor in the determination of the rapid shallow breathing index. Critical Care Medicine 36:5, 1692-1693
CrossRef50
Dominic Dellweg, Peter Haidl, Karsten Siemon, Patrick Appelhans, Dieter Kohler. (2008) Impact of breathing pattern on work of breathing in healthy subjects and patients with COPD. Respiratory Physiology & Neurobiology 161:2, 197-200
CrossRef51
Mohamad F. El-Khatib, Salah M. Zeineldine, Ghassan W. Jamaleddine. (2008) Effect of pressure support ventilation and positive end expiratory pressure on the rapid shallow breathing index in intensive care unit patients. Intensive Care Medicine 34:3, 505-510
CrossRef52
Michael J. Apostolakos. 2008. Weaning. , 624-626.
CrossRef53
Ji Hyun Jeon, Ran Namgung, Min Soo Park, Kook In Park, Chul Lee. (2008) Oxygenation index as a respiratory parameter of respiratory distress syndrome in preterm infants. Korean Journal of Pediatrics 51:2, 145
CrossRef54
J.-P. Viale, S. Duperret, P. Branche, M.-O. Robert, M. Muller. (2008) Ventilazione artificiale II: strategie ventilatorie. Logistica della ventilazione meccanica. EMC - Anestesia-Rianimazione 13:2, 1-19
CrossRef55
Irene Rozet, Karen B. Domino. (2007) Respiratory care. Best Practice & Research Clinical Anaesthesiology 21:4, 465-482
CrossRef56
Vasileios Bekos, John J. Marini. (2007) Monitoring the Mechanically Ventilated Patient. Critical Care Clinics 23:3, 575-611
CrossRef57
Jonathan M. Siner, Constantine A. Manthous. (2007) Liberation from Mechanical Ventilation: What Monitoring Matters?. Critical Care Clinics 23:3, 613-638
CrossRef58
E. L’Her. (2007) Une balance hydrique positive et un rapport FR/Vt élevé sont des facteurs de risqué d’échec d’une extubation programmée. Revue des Maladies Respiratoires 24, 154-155
CrossRef59
Nizar Eskandar, Michael J. Apostolakos. (2007) Weaning from Mechanical Ventilation. Critical Care Clinics 23:2, 263-274
CrossRef60
Rudolph L. Koch. (2007) Therapist Driven Protocols: A Look Back and Moving into the Future. Critical Care Clinics 23:2, 149-159
CrossRef61
Chul Ho Chang, Yong Woo Hong, Shin Ok Koh. (2007) Weaning Approach with Weaning Index for Postoperative Patients with Mechanical Ventilator Support in the ICU. Korean Journal of Anesthesiology 53:3, S47
CrossRef62
Salvatore Grasso, Antonio Leone, Michele De Michele, Roberto Anaclerio, Aldo Cafarelli, Giovanni Ancona, Tania Stripoli, Francesco Bruno, Paolo Pugliese, Michele Dambrosio, Lidia Dalfino, Francesca Di Serio, Tommaso Fiore. (2007) Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease*. Critical Care Medicine 35:1, 96-105
CrossRef63
Martin J. Tobin, Amal Jubran. (2006) Variable performance of weaning-predictor tests: role of Bayes' theorem and spectrum and test-referral bias. Intensive Care Medicine 32:12, 2002-2012
CrossRef64
Mohamad F. El-Khatib. (2006) The effect of positive end-expiratory pressure on the rapid shallow breathing index. Critical Care Medicine 34:11, 2867
CrossRef65
Maged A. Tanios, Michael L. Nevins, Katherine P. Hendra, Pierre Cardinal, Jill E. Allan, Elena N. Naumova, Scott K. Epstein. (2006) A randomized, controlled trial of the role of weaning predictors in clinical decision making*. Critical Care Medicine 34:10, 2530-2535
CrossRef66
Henry E. Fessler. (2006) Does weaning postpone liberation?*. Critical Care Medicine 34:10, 2676-2677
CrossRef67
Martin J. Tobin. (2006) Remembrance of weaning past: the seminal papers. Intensive Care Medicine 32:10, 1485-1493
CrossRef68
Miquel Ferrer, Pilar Martinez, Antoni Torres. (2006) Intermediate Respiratory Care Units. Clinical Pulmonary Medicine 13:5, 289-295
CrossRef69
John J. Marini. (2006) Breathing patterns as integrative weaning predictors: Variations on a theme*. Critical Care Medicine 34:8, 2241-2243
CrossRef70
Marc Wysocki, Christophe Cracco, Antonio Teixeira, Alain Mercat, Jean-Luc Diehl, Yannick Lefort, Jean-Philippe Derenne, Thomas Similowski. (2006) Reduced breathing variability as a predictor of unsuccessful patient separation from mechanical ventilation*. Critical Care Medicine 34:8, 2076-2083
CrossRef71
P. Casaseca-De-La-Higuera, M. Martin-Fernandez, C. Alberola-Lopez. (2006) Weaning From Mechanical Ventilation: A Retrospective Analysis Leading to a Multimodal Perspective. IEEE Transactions on Biomedical Engineering 53:7, 1330-1345
CrossRef72
Russell R Miller, E Wesley Ely. (2006) Radiographic measures of intravascular volume status: the role of vascular pedicle width. Current Opinion in Critical Care 12:3, 255-262
CrossRef73
Steven R. Knoper, Stuart F. Quan. 2006. Ventilatory Monitoring. .
CrossRef74
Louise Rose, Adult Ed. (2006) Advanced Modes of Mechanical Ventilation. AACN Advanced Critical Care 17:2, 145-159
CrossRef75
Louise Rose, Sioban Nelson. (2006) Issues in weaning from mechanical ventilation: literature review. Journal of Advanced Nursing 54:1, 73-85
CrossRef76
Carlo Alberto Volta, Valentina Alvisi, Sara Bertacchini, Elisabetta Marangoni, Riccardo Ragazzi, Marco Verri, Raffaele Alvisi. (2006) Acute effects of hyperoxemia on dyspnoea and respiratory variables during pressure support ventilation. Intensive Care Medicine 32:2, 223-229
CrossRef77
Anupama Upadya, Lisa Tilluckdharry, Visvanathan Muralidharan, Yaw Amoateng-Adjepong, Constantine A. Manthous. (2005) Fluid balance and weaning outcomes. Intensive Care Medicine 31:12, 1643-1647
CrossRef78
Michael L. Ault, M. Christine Stock. (2005) Respiratory Monitoring. International Anesthesiology Clinics 42:1, 97-112
CrossRef79
Ubaldo J. Martin, Luis Hincapie, Mark Nimchuk, John Gaughan, Gerard J. Criner. (2005) Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation. Critical Care Medicine 33:10, 2259-2265
CrossRef80
A. Torres, M. Ferrer, J.B. Blanquer, M. Calle, V. Casolivé, J.M. Echave, D.M. Masa. (2005) Unidades de cuidados respiratorios intermedios. Definición y características. Archivos de Bronconeumología 41:9, 505-512
CrossRef81
Vicki A. Lindgren, Nancy J. Ames. (2005) Caring for Patients on Mechanical Ventilation. AJN, American Journal of Nursing 105:5, 50-60
CrossRef82
A. Demoule. (2005) Exploration de la fonction des muscles respiratoires en réanimation. Revue des Maladies Respiratoires 22:1, 86-99
CrossRef83
Rick Harrison. 2005. Postoperative Intensive Care Management in Children. , 853-864.
CrossRef84
Hugo Tannus Furtado de Mendonça-Filho, Renato Vieira Gomes, Luis Antonio de Almeida Campos, Bernardo Tura, Edson Magalhães Nunes, Rachel Gomes, Fernando Bozza, Patricia T Bozza, Hugo Caire Castro-Faria-Neto. (2004) CIRCULATING LEVELS OF MACROPHAGE MIGRATION INHIBITORY FACTOR ARE ASSOCIATED WITH MILD PULMONARY DYSFUNCTION AFTER CARDIOPULMONARY BYPASS. Shock 22:6, 533-537
CrossRef85
C. Y. So, C. D. Gomersall, P. T. Chui, M. T. V. Chan. (2004) Performance of an oxygen delivery device for weaning potentially infectious critically ill patients*. Anaesthesia 59:7, 710-714
CrossRef86
Ali A.El Solh, Abid Bhat, Hakan Gunen, Eileen Berbary. (2004) Extubation failure in the elderly. Respiratory Medicine 98:7, 661-668
CrossRef87
Ben-Chung Cheng, Wen-Neng Chang, Chen-Sheng Chang, Nai-Wen Tsai, Chin-Jung Chang, Pi-Lien Hung, Kuo-Wei Wang, Jin-Bor Chen, Chien-Yu Tsai, Kuo-Tai Hsu, Hsueh-Wen Chang, Cheng-Hsien Lu. (2004) Predictive Factors and Long-Term Outcome of Respiratory Failure after Guillain-Barré Syndrome. The American Journal of the Medical Sciences 327:6, 336-340
CrossRef88
C. Haberthur, G. Mols, S. Elsasser, R. Bingisser, R. Stocker, J. Guttmann. (2002) Extubation after breathing trials with automatic tube compensation, T-tube, or pressure support ventilation. Acta Anaesthesiologica Scandinavica 46:8, 973-979
CrossRef89
Seetharaman Hariharan, Areti Y. Kumar, Anitha Shenoy. (2002) Bedside indices to predict weaning from mechanical ventilation. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 49:7, 761-762
CrossRef90
Arnaud de Lassence, Corinne Alberti, Élie Azoulay, Eric Le Miere, Christine Cheval, François Vincent, Yves Cohen, Maïté Garrouste-Orgeas, Christophe Adrie, Gilles Troche, Jean-François Timsit. (2002) Impact of Unplanned Extubation and Reintubation after Weaning on Nosocomial Pneumonia Risk in the Intensive Care Unit. Anesthesiology 97:1, 148-156
CrossRef91
Scott K. Epstein. (2001) Controversies in Weaning from Mechanical Ventilation. Journal of Intensive Care Medicine 16:6, 270-286
CrossRef92
Lourdes E. Flaminiano, Bartolome R. Celli. (2001) RESPIRATORY MUSCLE TESTING. Clinics in Chest Medicine 22:4, 661-677
CrossRef93
E. Wesley Ely, Allen C. Smith, Caroline Chiles, Suzanne L. Aquino, Tom S. Harle, Gregory W. Evans, Edward F. Haponik. (2001) Radiologic determination of intravascular volume status using portable, digital chest radiography: A prospective investigation in 100 patients. Critical Care Medicine 29:8, 1502-1512
CrossRef94
Anna C. Watson, Philip D. Hughes, M. Louise Harris, Nicholas Hart, Robert J. Ware, Julia Wendon, Malcolm Green, John Moxham. (2001) Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit. Critical Care Medicine 29:7, 1325-1331
CrossRef95
Tobin, Martin J., . (2001) Advances in Mechanical Ventilation. New England Journal of Medicine 344:26, 1986-1996
Full Text96
Thomas Genuit, Grant Bochicchio, Lena M. Napolitano, Robert J. McCarter, Mary-Claire Roghman. (2001) Prophylactic Chlorhexidine Oral Rinse Decreases Ventilator-Associated Pneumonia in Surgical ICU Patients. Surgical Infections 2:1, 5-18
CrossRef97
Michael L. Nevins, Scott K. Epstein. (2001) Weaning from prolonged mechanical ventilation. Clinics in Chest Medicine 22:1, 13-33
CrossRef98
Elizabeth Henneman, Kathleen Dracup, Tomas Ganz, Orna Molayeme, Christopher Cooper. (2001) Effect of a collaborative weaning plan on patient outcome in the critical care setting. Critical Care Medicine 29:2, 297-303
CrossRef99
F. Javier Hurtado, Marta Berón, Walter Olivera, Román Garrido, José Silva, Elia Caragna, Daniel Rivara. (2001) Gastric intramucosal pH and intraluminal Pco2 during weaning from mechanical ventilation. Critical Care Medicine 29:1, 70-76
CrossRef100
Kunihiko Hoshi, Yutaka Ejima, Ryuichi Hasegawa, Kohji Saitoh, Shun Satoh, Shuh Matsukawa. (2001) Differences in Respiratory Parameters during Continuous Positive Airway Pressure and Pressure Support Ventilation in Infants and Children.. The Tohoku Journal of Experimental Medicine 194:1, 45-54
CrossRef101
Suzanne M. Burns, Beverly Ryan, James E. Burns. (2000) The weaning continuum use of Acute Physiology and Chronic Health Evaluation III, Burns Wean Assessment Program, Therapeutic Intervention Scoring System, and Wean Index scores to establish stages of weaning. Critical Care Medicine2259-2267
CrossRef102
Ari Uusaro, Dean R. Chittock, James A. Russell, Keith R. Walley. (2000) Stress test and gastric-arterial Pco2 measurement improve prediction of successful extubation. Critical Care Medicine2313-2319
CrossRef103
Rafael Barrera, Jose Melendez, Michael Ahdoot, Ying Huang, Denis Leung, Jeffrey S. Groeger. (1999) Flow triggering added to pressure support ventilation improves comfort and reduces work of breathing in mechanically ventilated patients. Journal of Critical Care 14:4, 172-176
CrossRef104
Alan D Brook, Marin H Kollef. (1999) An Outcomes-Based Approach to Ventilatory Management: Review of Two Examples. Journal of Intensive Care Medicine 14:6, 262-274
CrossRef105
Theodoros Vassilakopoulos, Charis Roussos, Spyros Zakynthinos. (1999) Weaning from mechanical ventilation. Journal of Critical Care 14:1, 39-62
CrossRef106
Milo Engoren. (1998) Approximate entropy of respiratory rate and tidal volume during weaning from mechanical ventilation. Critical Care Medicine 26:11, 1817-1823
CrossRef107
D CHAO, D SCHEINHORN. (1998) WEANING FROM MECHANICAL VENTILATION. Critical Care Clinics 14:4, 799-817
CrossRef108
K GRACE. (1998) THE VENTILATOR:Selection of Mechanical Ventilators. Critical Care Clinics 14:4, 563-580
CrossRef109
Gilles Hilbert, Marie Luce Choukroun, Georges Gbikpi-Benissan, Hervé Guenard, Jean Pierre Cardinaud. (1998) Optimal pressure support level for beginning weaning in patients with COPD: Measurement of diaphragmatic activity with step-by-step decreasing pressure support level. Journal of Critical Care 13:3, 110-118
CrossRef110
C.-C. Huang, M.-C. Lin, C.-T. Yang, R.-S. Lan, Y.-H. Tsai, T.C.Y. Tsao. (1998) Oxygen, arterial blood gases and ventilation are unchanged during dialysis in patients receiving pressure support ventilation. Respiratory Medicine 92:3, 534-540
CrossRef111
Brenda L. Baumeister, Mohamad El-Khatib, Paul G. Smith, Jeffrey L. Blumer. (1997) Evaluation of predictors of weaning from mechanical ventilation in pediatric patients. Pediatric Pulmonology 24:5, 344-352
CrossRef112
Jay A Johannigman, Kenneth Davis, Robert S Campbell, Richard D Branson, Fred A Luchette, James M Hurst. (1997) Use of the rapid/shallow breathing index as an indicator of patient work of breathing during pressure support ventilation. Surgery 122:4, 737-741
CrossRef113
Luis Rivera, Charles Weissman. (1997) Dynamic Ventilatory Characteristics During Weaning in Postoperative Critically III Patients. Anesthesia & Analgesia 84:6, 1250-1255
CrossRef114
(1997) Duration of Mechanical Ventilation. New England Journal of Medicine 336:22, 1610-1611
Full Text115
Ely, E. Wesley, Baker, Albert M., Dunagan, Donnie P., Burke, Henry L., Smith, Allen C., Kelly, Patrick T., Johnson, Margaret M., Browder, Rick W., Bowton, David L., Haponik, Edward F., . (1996) Effect on the Duration of Mechanical Ventilation of Identifying Patients Capable of Breathing Spontaneously. New England Journal of Medicine 335:25, 1864-1869
Full Text116
P. Saura, L. Blanch, J. Mestre, J. Vallés, A. Artigas, R. Fernández. (1996) Clinical consequences of the implementation of a weaning protocol. Intensive Care Medicine 22:10, 1052-1056
CrossRef117
Martin R. Lessard, Laurent J. Brochard. (1996) WEANING FROM VENTILATORY SUPPORT. Clinics in Chest Medicine 17:3, 475-489
CrossRef118
Orlando C. Kirton, C. Bryan DeHaven, Judith Hudson-Civetta, Joseph P. Morgan, Jimmy Windsor, Joseph M. Civetta. (1996) Re-Engineering Ventilatory Support to Decrease Days and Improve Resource Utilization. Annals of Surgery 224:3, 396-404
CrossRef119
Amal Jubran, Martin J. Tobin. (1996) MONITORING DURING MECHANICAL VENTILATION. Clinics in Chest Medicine 17:3, 453-473
CrossRef120
Neil R. MacIntyre. (1996) NEW MODES OF MECHANICAL VENTILATION. Clinics in Chest Medicine 17:3, 411-421
CrossRef121
Howard Belzberg, Edward E. Cornwell, Thomas V. Berne. (1996) THE CRITICAL CARE OF THE SEVERELY INJURED PATIENT—II. Surgical Clinics of North America 76:4, 971-983
CrossRef122
E. A. Leitch, J. L. Moran, B. Grealy. (1996) Weaning and extubation in the intensive care unit. Intensive Care Medicine 22:8, 752-759
CrossRef123
James B. Knox, Douglas W. Wilmore, Robert H. Demling, Pasha Sarraf, Alfred A. Santos. (1996) Use of growth hormone for postoperative respiratory failure. The American Journal of Surgery 171:6, 576-580
CrossRef124
M. F. El-Khatib, B. Baumeister, P. G. Smith, R. L. Chatburn, J. L. Blumer. (1996) Inspiratory pressure/maximal inspiratory pressure: does it predict successful extubation in critically ill infants and children?. Intensive Care Medicine 22:3, 264-268
CrossRef125
A. Rossi, G. Polese, G. Brandi, G. Conti. (1995) Intrinsic positive end-expiratory pressure (PEEPi). Intensive Care Medicine 21:6, 522-536
CrossRef126
E. Zanotti, F. Rubini, G. Iotti, A. Braschi, A. Palo, C. Bruschi, C. Fracchia, S. Nava. (1995) Elevated static compliance of the total respiratory system: Early predictor of weaning unsuccess in severe COPD patients mechanically ventilated. Intensive Care Medicine 21:5, 399-405
CrossRef127
Weinberger, Steven E., Weiss, J. Woodrow, . (1995) Weaning from Ventilatory Support. New England Journal of Medicine 332:6, 388-389
Full Text128
Kirk A. Miller, Christopher P. Harkin, Peter L. Bailey. (1995) Postoperative Tracheal Extubation. Anesthesia & Analgesia 80:1, 149-172
CrossRef129
Gail L. Ingersoll, Sandra K. Goodnough-Hanneman, Ann R. Knebel, Maureen E. Shekleton, Suzanne M. Burns, John M. Clochesy. (1995) Measurement Issues in Mechanical Ventilation Weaning Research. Worldviews on Evidence-Based Nursing E2:1, 94-102
CrossRef130
Susan K. Chase. (1994) The Research Basis for Weaning from Mechanical Ventilation. Worldviews on Evidence-Based Nursing E1:1, 52-60
CrossRef131
R. W. M. Wahba, K. L. Yang. (1994) Letter to the editor. Intensive Care Medicine 20:7, 529-531
CrossRef132
I. L. Cohen. (1994) Weaning from mechanical ventilation — the team approach and beyond. Intensive Care Medicine 20:5, 317-318
CrossRef133
Tobin, Martin J.. (1994) Mechanical Ventilation. New England Journal of Medicine 330:15, 1056-1061
Full Text134
A. S. Slutsky. (1994) Consensus conference on mechanical ventilation-January 28–30, 1993 at Northbrook, Illinois, USA. Intensive Care Medicine 20:2, 150-162
CrossRef135
W Peterson, W Charlifue, A Gerhart, G Whiteneck. (1994) Two methods of weaning persons with quadriplegia from mechanical ventilators. Paraplegia 32:2, 98-103
CrossRef136
M. T. P. Caldwell, P. G. Murphy, R. Page, T. N. Walsh, T. P. J. Hennessy. (1993) Timing of extubation after oesophagectomy. British Journal of Surgery 80:12, 1537-1539
CrossRef137
K. L. Yang. (1993) Inspiratory pressure/maximal inspiratory pressure ratio: a predictive index of weaning outcome. Intensive Care Medicine 19:4, 204-208
CrossRef138
L.J. Restrick, A.D. Scott, E.M. Ward, R.O. Feneck, W.E. Cornwell, J.A. Wedzicha. (1993) Nasal intermittent positive-pressure ventilation in weaning intubated patients with chronic respiratory disease from assisted intermittent, positive-pressure ventilation. Respiratory Medicine 87:3, 199-204
CrossRef139
F. Lemaire. (1993) Difficult weaning. Intensive Care Medicine 19:S2, S69-S73
CrossRef140
F. Gandia, J. Blanco. (1992) Evaluation of indexes predicting the outcome of ventilator weaning and value of adding supplemental inspiratory load. Intensive Care Medicine 18:6, 327-333
CrossRef141
M. J. Tobin. (1992) Breathing pattern analysis. Intensive Care Medicine 18:4, 193-201
CrossRef142
(1991) Indexes Predictive of Weaning from Mechanical Ventilation. New England Journal of Medicine 325:20, 1442-1444
Full Text143
Marini, John J., . (1991) Weaning from Mechanical Ventilation. New England Journal of Medicine 324:21, 1496-1498
Full Text
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