![]() Two prospective observational studies showed that reduced heart rate variability during spontaneous breathing trials (SBT) was significantly associated with extubation failure (-). The process of weaning leads to changes in the hemodynamic and autonomic nervous systems. In the present article, we review some of the recent studies about weaning predictors, criteria, procedure, as well as assessment for extubation a mechanically ventilated patient. Although the international consensus conference in 2005 did not recommend their routine use for clinical decision making, researchers did not stop working in this area ( 9). Weaning predictors are parameters that are intended to help clinicians predict whether weaning attempts will be successful or not. However, it should be kept in mind that some patients who don't meet these criteria are eventually successfully weaned ( 8). Usually the criteria used are improvement of gas exchange, improvement of mental status, neuromuscular functional assessment and radiographic signs ( 7). A combination of subjective and objective criteria is usually used to determine disease reversal. There is no consensus about what criteria should be used to assess reversal of the underlying condition. The collective task force in 2001 stated that the process of SBT and weaning should start by assessing whether the underlying cause of respiratory failure has been resolved or not ( 2). Spontaneous breathing trial (SBT) assesses the patient's ability to breathe while receiving minimal or no ventilator support. On the other hand, premature weaning can lead to complications like loss of the airway, defective gas exchange, aspiration and respiratory muscle fatigue (-). Delayed weaning can lead to complications such as ventilator induced lung injury (VILI), ventilator associated pneumonia (VAP), and ventilator induced diaphragmatic dysfunction (-). It is estimated that 40% of the duration of mechanical ventilation is dedicated to the process of weaning ( 1). ![]() If the regulated abatement work area is determined to be acceptable, this qualified project monitor may authorize breakdown of the regulated abatement work area, removal of all remaining barriers and waste removal from the site.The term "weaning" is used to describe the gradual process of decreasing ventilator support. The full name and NYSDOL asbestos handling certificate number of the certified project monitor performing the inspection shall also be documented in the supervisor's daily log. An entry shall be made into the asbestos abatement contractor supervisor's daily log by both the supervisor and the project monitor performing the inspection, detailing the findings of the visual inspection. The asbestos abatement contractor and property owner, prior to the scheduling of the required visual inspection, shall provide a complete abatement scope of work for the asbestos project to the project monitor. If the property owner is the asbestos abatement contractor for the asbestos project, the owner shall contract with an independent project monitoring firm asbestos contractor for the necessary visual inspection on the asbestos project. The project monitor visual inspection for completeness of abatement and completeness of cleanup shall be performed as per the provisions of the current ASTM standard E1368 "Standard Practice for Visual Inspection of Asbestos Abatement Projects". An appropriately trained and certified project monitor, contracted by the building/structure owner, independent of the asbestos abatement contractor, shall complete the visual inspection.
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