The Difficult-to-wean Patient

Nicolino Ambrosino; Luciano Gabbrielli


Expert Rev Resp Med. 2010;4(5):685-692. 

In This Article

Five-year View

The aforementioned fundamental questions are relevant, but, independent of ethical, religious and even economical considerations, the present evidence does not allow a definite response and it is hard to believe that it will be found in the next 5 years. Many factors prevent research on this topic. The successes of ICUs in achieving short-term survival have prevented this area to be recognized as an important focus of scientific investigation. Areas to be researched in the near future are the different facilities available to care for these patients, with the problem of generalization from one setting to another. In the near future, a consensus on a definition of this condition needs to be reached. A common definition would be beneficial for interventional studies in which patients are prospectively enrolled. A large multicenter, multicountry research network including a broad range of venues for care of the chronically critically ill should be supported and developed. Studies on pathobiology and pathophysiology of chronic critical illness as distinct from acute critical illness are needed. We also need well-designed trials testing approaches to the best management of prolonged MV (including setting, protocols and interfaces), nutritional support, delirium, symptoms (drug therapy of dyspnea) and physical weakness. Comparative research of economic analyses should be conducted to compare the cost–effectiveness of care in acute hospitals versus at specialized facilities versus home.


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