2 thoughts on “TIRBO #3: Weaning vs Titration”

  1. Hi Brandon,

    For some context I am a physiotherapist working on an intensive care unit in the UK.

    I really enjoy the concept of wean vs titration and I feel very much on board with a shift, especially with regards to FiO2 reduction to what they actually require. This idea of appropriate language change, reminds me of the shift of “wear and tear” to “wear and repair”. I brought this topic up before a critical care handover and an area of large discussion was centred around trachea weaning. Would a patient that has had a trachea in situ for a prolonged period of time fit closer within the weaning category due to their respiratory deconditioning or do you feel titration is still more appropriate?

    I appreciate this is a very non specific question which could hypothetically present in a large number of ways but I guess, to try and simplify. Do you feel in most cases patients with a trachea in situ are being titrated off and those who have very prolonged tracheas are exceptional circumstances which requires being weaned?

    I hope this makes sense, and look forward to your thoughts.
    Kind regards

    1. Hey Nader! Great question. There is probably a lot of nuance to this, and someone who really specializes in long-term vent weaning might have a different take. I think a lot of these cases are true weaning, as these are patients who have demonstrated a prolonged dependence on the trach which will likely resolve gradually (as their respiratory strength improves, pulmonary processes resolve, etc). From that respect, gradually reducing the support offered by a trach might be appropriate to match the patient’s needs. However, you never really know where the patient is at without testing them, which is why the process often look a little more stepwise than other titrations – downsizing or plugging a trach is like saying, “I believe you’re ready for your breathing to rely less on your trach, but we won’t know until we try.” It’s like a spontaneous breathing trial on the vent – in a sense it’s a reduction in the level of therapy, but more because you suspect you’re currently oversupporting them (i.e. they might not need ventilation at all) than an attempt to closely match the patient’s needs, the way you might in a chronic wean.

      Just some philosophical musings.

Leave a Reply

Your email address will not be published. Required fields are marked *