title: Is failure to awaken and wean malpractice?
abstract: Respiratory failure is among the most common primary causes of or complications of critical illness, and although mechanical ventilation can be lifesaving, it also engenders substantial risk of morbidity and mortality to patients. Three decades of research suggests that the duration of invasive mechanical ventilation can be reduced substantially, reducing morbidity and mortality. Mean duration of ventilation reported in recent international studies suggests a quality chasm in management of this common critical illness.
  
  
  
  This is a selective review of the literature and synthesis with precepts of medical professionalism and ethics.
  
  
  
  To the extent that daily wake-up-and-breathe reduces morbidity, mortality, and length of stay, failure to deploy this strategy is, by definition, malpractice (ie, poor practice). Practical measures are offered to close this quality chasm.
authors.affiliation: 6 Hemingway Road, Niantic, CT. Electronic address: constantinemanthous@gmail.com.
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Manthous
mesh_terms: D003422:Critical Care / Q000191:economics / Q000592:standards*; D016638:Critical Illness; D019317:Evidence-Based Medicine; D006801:Humans; D008318:Malpractice; D009017:Morbidity; D009026:Mortality; D011787:Quality of Health Care; D012121:Respiration, Artificial / Q000191:economics / Q000592:standards*; D012131:Respiratory Insufficiency / Q000628:therapy*; D015300:Ventilator Weaning / Q000191:economics / Q000592:standards*
keywords: Mechanical ventilation; Quality chasm; Respiratory failure; Weaning