To Wean or Not to Wean: A Practical Patient Focused Guide to Ventilator Weaning

Abstract

Since the inception of critical care medicine and artificial ventilation, literature and research on weaning has transformed daily patient care in intensive care units (ICU). As our knowledge of mechanical ventilation (MV) improved, so did the need to study patient-ventilator interactions and weaning predictors. Randomized trials have evaluated the use of protocol-based weaning (vs. usual care) to study the duration of MV in ICUs, different techniques to conduct spontaneous breathing trials (SBT), and strategies to eventually extubate a patient whose initial SBT failed. Despite considerable milestones in the management of multiple diseases contributing to reversible respiratory failure, in the application of early rehabilitative interventions to preserve muscle integrity, and in ventilator technology that mitigates against ventilator injury and dyssynchrony, major barriers to successful liberation from MV persist. This review provides a broad encompassing view of weaning classification, causes of weaning failure, and evidence behind weaning predictors and weaning modes.

Weaning Difficulty in Patient with End Stage Renal Disease Acute with Respiratory Failure due to Pulmonary Edema and Pneumonia

“…Ventilation supports goal is to correct hypoxemia and elimination of CO2, with supportive method and pharmacological For prevent injury lungs further. [1] Ventilator setup starts with pressure control with PC 20 RR 20 PEEP 8 FiO2 80% then lowered in accordance patient response with a target of tidal volume 6 mL/kg, PP ≤30 cmH2 O, SpO2 88%-92%. [4] He got infection symptoms such as fever, worsening breathing, leukocytosis, purulent sputum and culture examination of sputum material showed Acinobacter baumanii, which is assessed with CPIS score >6, indicating the presence of pneumonia.…”

“…Positive fluid balance on ESRD 5D patient will increase risk of death, and complication like pulmonary edema, lung infection will cause disturbance of gas exchange, decline compliance and increasing WOB, exacerbate respiratory failure as well as improve need mechanical ventilation Fluid Restriction done to prevent fluid overloaded. [1,7] This case report discuss the complication pf mechanical ventilation weaning in ESRD 5D patients who experienced respiratory failure due to pulmonary edema and pneumonia which treated in ICU of Hasan Sadikin Bandung Hospital for 18-20 days. During pulmonary edema and pneumonia were contracted which improved during the process of treatment so weaning from mechanical ventilation could be done.…”

“…Infection And fluid accumulation is the main cause of death in ESRD patients. [1][2][3][4][5][6][7] Mechanical ventilation can complicate weaning due to various reasons, including weakness muscle, enhancement burden respiration, disturbance drives ventilation, disturbance oxygen carrying capacity, cardiac dysfunction and disturbance of sputum cleaning. [1,6,8] Other predictor of weaning complication is old age, long mechanical ventilation usage, lung infection or history of chronic obstructive pulmonary disease and positive fluid accumulation balance.…”

“…[1][2][3][4][5][6][7] Mechanical ventilation can complicate weaning due to various reasons, including weakness muscle, enhancement burden respiration, disturbance drives ventilation, disturbance oxygen carrying capacity, cardiac dysfunction and disturbance of sputum cleaning. [1,6,8] Other predictor of weaning complication is old age, long mechanical ventilation usage, lung infection or history of chronic obstructive pulmonary disease and positive fluid accumulation balance. Positive fluid balance on ESRD 5D patient will increase risk of death, and complication like pulmonary edema, lung infection will cause disturbance of gas exchange, decline compliance and increasing WOB, exacerbate respiratory failure as well as improve need mechanical ventilation Fluid Restriction done to prevent fluid overloaded.…”

Physical and respiratory therapy in the critically ill patient with obesity: a narrative review

“…The weaning process from IMV and NIV support can be a challenging task for clinical professionals when caring for critically ill obese patients, alongside the respiratory care provided during IMV ( 47 , 48 ). There is a scarcity of evidence, established practices, and specific cutoff points for this weaning process.…”