Prolonged Weaning

In 25% of critically ill patients, weaning from mechanical ventilation takes longer than 10 days; indeed, 5–10% of patients still require ventilation at 30 days. Those with prolonged weaning, after adjustment for other variables, have a higher mortality within the intensive care unit than those without weaning delay or failure. The pathophysiological processes that result in weaning failure are complex and result of an imbalance between the neural respiratory drive, respiratory muscle load, and capacity. The clinical conditions resulting in these pathophysiological conditions should be methodically considered in patients requiring prolonged weaning. These patients often need a personalized weaning and rehabilitation approach, based on their underlying pathological condition as well as their psychological and physiological status.

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Respiratory Muscle Effort during Expiration in Successful and Failed Weaning from Mechanical Ventilation

Anesthesiology ◽

10.1097/aln.0000000000002256 ◽

2018 ◽

Vol 129 (3) ◽

pp. 490-501 ◽

Cited By ~ 20

Author(s):

Jonne Doorduin ◽

Lisanne H. Roesthuis ◽

Diana Jansen ◽

Johannes G. van der Hoeven ◽

Hieronymus W. H. van Hees ◽

...

Keyword(s):

Mechanical Ventilation ◽

Electrical Activity ◽

Muscle Activity ◽

Respiratory Muscle ◽

Weaning From Mechanical Ventilation ◽

Expiratory Muscle ◽

Diaphragm Electrical Activity ◽

Gastric Pressure ◽

Weaning Failure ◽

Expiratory Muscles

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Respiratory muscle weakness in critically ill patients is associated with difficulty in weaning from mechanical ventilation. Previous studies have mainly focused on inspiratory muscle activity during weaning; expiratory muscle activity is less well understood. The current study describes expiratory muscle activity during weaning, including tonic diaphragm activity. The authors hypothesized that expiratory muscle effort is greater in patients who fail to wean compared to those who wean successfully. Methods Twenty adult patients receiving mechanical ventilation (more than 72 h) performed a spontaneous breathing trial. Tidal volume, transdiaphragmatic pressure, diaphragm electrical activity, and diaphragm neuromechanical efficiency were calculated on a breath-by-breath basis. Inspiratory (and expiratory) muscle efforts were calculated as the inspiratory esophageal (and expiratory gastric) pressure–time products, respectively. Results Nine patients failed weaning. The contribution of the expiratory muscles to total respiratory muscle effort increased in the “failure” group from 13 ± 9% at onset to 24 ± 10% at the end of the breathing trial (P = 0.047); there was no increase in the “success” group. Diaphragm electrical activity (expressed as the percentage of inspiratory peak) was low at end expiration (failure, 3 ± 2%; success, 4 ± 6%) and equal between groups during the entire expiratory phase (P = 0.407). Diaphragm neuromechanical efficiency was lower in the failure versus success groups (0.38 ± 0.16 vs. 0.71 ± 0.36 cm H2O/μV; P = 0.054). Conclusions Weaning failure (vs. success) is associated with increased effort of the expiratory muscles and impaired neuromechanical efficiency of the diaphragm but no difference in tonic activity of the diaphragm.

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Predictors and Outcomes of Prolonged Weaning Among Intubated Patients on Mechanical Ventilation Admitted to the Intensive Care Unit

CHEST Journal ◽

10.1016/j.chest.2016.02.168 ◽

2016 ◽

Vol 149 (4) ◽

pp. A162

Author(s):

Andre Awaloei

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Prolonged Weaning

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Comparative study of two methods of weaning from mechanical ventilation in a cancer surgical intensive care unit

Critical Care ◽

10.1186/cc5332 ◽

2007 ◽

Vol 11 (Suppl 2) ◽

pp. P172

Author(s):

W Salem ◽

N Fahmy

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Comparative Study ◽

Surgical Intensive Care Unit ◽

Weaning From Mechanical Ventilation ◽

Surgical Intensive Care

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Nurses-Driven, Protocol-Directed Weaning From Mechanical Ventilation: Clinical Consequences and Acceptance by Intensive Care Unit Physicians

CHEST Journal ◽

10.1378/chest.1107985 ◽

2011 ◽

Vol 140 (4) ◽

pp. 1028A

Author(s):

Mauricio Danckers ◽

Hassan Khouli ◽

Horiana Grosu ◽

Raul Cruz ◽

Nagesh Javhad ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Weaning From Mechanical Ventilation ◽

Clinical Consequences

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Comparison of a preventive or curative strategy of fluid removal on the weaning of mechanical ventilation: a study protocol for a multicentre randomised open-label parallel-group trial

BMJ Open ◽

10.1136/bmjopen-2020-048286 ◽

2021 ◽

Vol 11 (8) ◽

pp. e048286

Author(s):

Martin Dres ◽

Candice Estellat ◽

Jean-Luc Baudel ◽

François Beloncle ◽

Julien Cousty ◽

...

Keyword(s):

Mechanical Ventilation ◽

Fluid Balance ◽

Primary Outcome ◽

Controlled Trial ◽

Total Duration ◽

Preventive Strategy ◽

Weaning From Mechanical Ventilation ◽

Metabolic Complications ◽

Fluid Removal ◽

Weaning Failure

IntroductionFluid overload is associated with a poor prognosis in the critically ill patients, especially at the time of weaning from mechanical ventilation as it may promote weaning failure from cardiac origin. Some data suggest that early administration of diuretics would shorten the duration of mechanical ventilation. However, this strategy may expose patients to a higher risk of haemodynamic and metabolic complications. Currently, there is no recommendation for the use of diuretics during weaning and there is an equipoise on the timing of their initiation in this context.Methods and analysisThis study is a multicentre randomised controlled trial comparing two strategies of fluid removal during weaning in 13 French intensive care units (ICU). The preventive strategy is initiated systematically when the fluid balance or weight change is positive and the patients have criteria for clinical stability; the curative strategy is initiated only in case of weaning failure documented as of cardiac origin. Four hundred and ten patients will be randomised with a 1:1 ratio. The primary outcome is the duration of weaning from mechanical ventilation, defined as the number of days between randomisation and successful extubation (alive without reintubation nor tracheostomy within the 7 days after extubation) at day 28. Secondary outcomes include daily and cumulated fluid balance, metabolic and haemodynamic complications, ventilator-associated pneumonia, weaning complications, number of ventilator-free days, total duration of mechanical ventilation, the length of stay in ICU and mortality in ICU, in hospital and, at day 28. A subgroup analysis for the primary outcome is planned in patients with kidney injury (Kidney Disease: Improving Global Outcomes class 2 or more) at the time of randomisation.Ethics and disseminationThe study has been approved by the ethics committee (Comité de Protection des Personnes Paris 1) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT04050007.Protocol versionV.1; 12 March 2019.

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