A Practical Approach to the Difficult-to-Wean Patient

Jackson, M.; Strang, Tim; Rajalingam, Yadhunanthanan

doi:10.1177/175114371201300412

Cited by 5 publications

(4 citation statements)

References 47 publications

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“…The guidelines for weaning from ventilator were developed 10 years ago, 1 which required the patient to meet adequate criteria. 61 However, traditional weaning parameters are not good predictors of a successful outcome in neurocritical care; for this reason, these parameters are not reliable in neuroemergencies. 62 In a multicenter observational study, 37 which included patients with TBI, stroke, and subarachnoid hemorrhage, showed that the duration of MV is greater, compared with other groups of patients in the ICU presenting greater challenges to the clinician for weaning in the neurological patients.…”

Section: Complicationsmentioning

confidence: 99%

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

Quiñones-Ossa

Durango-Espinosa

Padilla-Zambrano

et al. 2020

JNRP

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Tracheostomy is the commonest bedside surgical procedure performed on patients needing mechanical ventilation with traumatic brain injury (TBI). The researchers made an effort to organize a narrative review of the indications, timing, management, complications, and outcomes of tracheostomy in relation to neuronal and brain-injured patients following TBI. The study observations were collated from the published literature, namely original articles, book chapters, case series, randomized studies, systematic reviews, and review articles. Information sorting was restricted to tracheostomy and its association with TBI. Care was taken to review the correlation of tracheostomy with clinical correlates including indications, scheduling, interventions, prognosis, and complications of the patients suffering from mild, moderate and severe TBIs using Glasgow Coma Scale, Glasgow Outcome Scale, intraclass correlation coefficient, and other internationally acclaimed outcome scales. Tracheostomy is needed to overcome airway obstruction, prolonged respiratory failure and as indispensable component of mechanical ventilation due to diverse reasons in intensive care unit. Researchers are divided over early tracheostomy or late tracheostomy from days to weeks. The conventional classic surgical technique of tracheostomy has been superseded by percutaneous techniques by being less invasive with lesser complications, classified into early and late complications that may be life threatening. Additional studies have to be conducted to validate and streamline varied observations to frame evidence-based practice for successful weaning and decannulation. Tracheostomy is a safer option in critically ill TBI patients for which a universally accepted protocol for tracheostomy is needed that can help to optimize indications and outcomes.

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Section: Complicationsmentioning

confidence: 99%

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

Quiñones-Ossa

Durango-Espinosa

Padilla-Zambrano

et al. 2020

JNRP

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Bangun

Suwarman

2023

JSocMed

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Introduction: End Stage Renal Disease (ESRD) 5D patient have potential to respiratory failure due to excess fluid, thus increasing the incidence of repeated hospital admissions. Deaths were reported in about 15%– 30% cases, where 50%–60% of patients needed respiratory support with mechanical ventilation. About 30%– 40% of patients had complications in the weaning process from mechanical ventilation. Prolonged mechanical ventilation increased mortality and morbidity, the length of stay periods and costs. Case Report: This case report will discuss the difficult weaning from mechanical ventilation in patients with ESRD 5D who have respiratory failure due to edema pulmonary and pneumonia who were hospitalized at the Intensive Care Unit (ICU) of Hasan Sadikin Hospital - Bandung for 20 days Conclusion: Weaning difficulty due to accumulation positive fluid balance during hospitalization lead to longer use of mechanical ventilation and pulmonary infection get heavier. A positive cumulative fluid balance could be one factor of weaning difficulty

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“…includes patients who require more than seven days after the first breathing trial [2]. Although difficult-to wean patients represents about 6 % of the patients inside the intensive care unit , they consume a third of resources [3] .…”

Section: Introductionmentioning

confidence: 99%

Comprehensive Rehabilitation Program Versus Traditional Chest Physiotherapy for Weaning from Mechanical Ventilator ; randomized clinical trial

ELmoutaz¹,

Rahmy²,

Eldin³

et al. 2020

Preprint

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Background Patients needing prolonged mechanical ventilation have poor outcomes and are increasing in number. Weakness of inspiratory muscles is a well- established complication of prolonged mechanical ventilator , however the role of physical therapist has been expanded towards rehabilitation rather than inspiratory care only. The purpose of this study was to compare between comprehensive rehabilitation program and traditional chest physiotherapy on weaning from mechanical ventilation, improvement of respiratory muscle strength, peripheral muscle strength and functional status.Methods Fifty mechanically ventilated general surgery patients from both sexes (men & women) with age from 40 to 50 years old participated in the present randomized clinical trial. They had difficult and prolonged weaning. They were divided randomly into two groups , group(A) consisted of twenty four patients who received comprehensive rehabilitation program combined with inspiratory muscle training and group(B) consisted of twenty six patients who received traditional chest physical therapy combined with inspiratory muscle training. Four patients in the study group and six subjects in the control group died during the intervention period and thus their data were excluded from the final analysis. Maximal inspiratory pressure (MIP), peripheral muscle strength and Functional independence measure questionnaire were measured at the beginning of the study and at weaning from mechanical ventilator.ResultsResults revealed that there was a significant improvement in days to wean and peripheral muscle strength in difficult and prolonged weaning patients in group A compared with group B. There was a significant improvement in maximal inspiratory pressure (MIP) in both groups. In addition, there was a significant increase in the median values of functional independence measures in group A more than group B.ConclusionsBoth physical therapy programs inspiratory muscle training and comprehensive rehabilitation and inspiratory muscle training and traditional chest physical therapy showed an increase in inspiratory muscle strength. On the other hand comprehensive program consisted of peripheral muscle training and functional training was more superior in decreasing days to wean and increasing peripheral muscle strength and functional independence measure score. The trial was prospectively registered at Clinicaltrials.gov ; Identifier: NCT04021615 ; date : 13-7-2019

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A Practical Approach to the Difficult-to-Wean Patient

Cited by 5 publications

References 47 publications

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients

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

Comprehensive Rehabilitation Program Versus Traditional Chest Physiotherapy for Weaning from Mechanical Ventilator ; randomized clinical trial

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