Neurormonal and inflammatory responses during weaning trials from mechanical ventilation

Abstract

IntroductionWeaning from mechanical ventilation is usually accomplished with spontaneous breathing trials. The discontinuation of mechanical ventilation and the resumption of spontaneous breathing may increase oxygen demands, and patients, mainly those with limited cardiorespiratory reserve, are subjected to pulmonary and cardiovascular stress. In addition, emotional distress due to agitation after interruption of sedative drugs, anxiety and other sources of discomfort potentially contributes to pulmonary and cardiovascular stress. There is evidence of metabolic and endocrine stress response expressed as an increase in oxygen consumption and plasma concentration of catecholamines and other hormones involved in the stress system activation, in patients during the weaning process from mechanical ventilation, especially during failing weaning attempts. Furthermore, extrapolating from both physical exercise and inspiratory resistive breathing data, there is evidence of immune response expressed as an increase of proinflammatory cytokine blood levels. The purpose of this review is to summarise the published information about neurormonal and inflammatory stress response during weaning from mechanical ventilation. Neurormonal and inflammatory responses during weaning trials from mechanical ventilationC Routsi*, V Papas, S Zakynthinos ConclusionThe stress response during weaning trials from mechanical ventilation has not been studied enough. Nevertheless, there is evidence that the process of weaning from mechanical ventilation incorporates hormonal, inflammatory and neuroendocrine responses, indicating that weaning might prove physically and psychologically stressful. Further studies should evaluate this stress response more thoroughly for better management of these patients.

Assessment of Some Predictors of Weaning from Mechanical Ventilation in Acutely Intoxicated Patients Admitted to the Poison Control Center-Ain Shams University

“…At present, no single predictor, or set of predictors, has the desired reliability and such a prediction remains a difficult challenge (Verona et al, 2015). Predictors also have the potential for identifying specific physiological changes responsible for weaning failure (Routsi et al, 2013). M There is available evidence for weaning-induced cytokine release; Interleukin-6 (IL-6) is one of the proinflammatory cytokines which is generated in response to stress factors such as high inspiratory load (Sellares et al, 2012).…”

N-Terminal Pro-Brain Natriuretic Peptide in Post Cardiac Surgery as a Predictor of Ventilator-Weaning Outcomes

“…Weaning mechanical ventilation in post cardiac surgery has remained problematic, especially in insufficient cardiopulmonary reserve patients. Too early weaning ventilation might stimulate the exaggerate inflammation process [1]. The over cardiopulmonary compensations that occur during ventilator weaning might lead to lethal acute respiratory and heart failure [2][3][4].…”