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Facilitation of Extubation With Physician-Assisted Cyberphysiologic Ventilatory Stabilization: Common Sense, Compassion, and Sensitivity Really Enhance Outcomes!

Ronald V. Marino, DO
Arch Pediatr Adolesc Med. 1994;148(5):545. doi:10.1001/archpedi.1994.02170050103027.
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A recent consultation prompted me to reconsider the physician's role in providing humanistic care and its efficacy in healing our patients. The patient was a 12-year-old white girl with chronic severe asthma who spent the 5 days before our meeting intubated in the pediatric intensive care unit (PICU). On the fifth day, her physiologic measurements indicated that she was ready for extubation. When her neuromuscular blockade was lifted, the patient became agitated and combative. Her respiratory status became unstable and she was reparalyzed and sedated. As a behavioral pediatrician, I was consulted to "hypnotize" her so that successful extubation could be accomplished.

The next morning, I arrived at the PICU to address the challenging request of my colleagues. The PICU was extremely active, with numerous intubated patients, many nurses, physicians, and respiratory therapists, and various medical and nursing students speaking above the cacophony of monitors, machines, and suction. Pausing at


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