Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1

Abstract

Although mechanical ventilation may be a patient's vital ally during acute illness, it can quickly transform into an enemy during chronic conditions. The weaning process is the fundamental phase that enables the resumption of physiological respiratory function; however, it is also associated with a number of life-threatening complications, and a large percentage of critically ill patients never achieve airway device removal or require the resumption of mechanical ventilation just a few days post-weaning. Indeed, the weaning process is, at present, more of an art than a science. As such, there is urgent need for novel contributions from the scientific literature to abate the growing rates of morbidity and mortality associated with weaning failure. The physician attempting to wean a patient must integrate clinical parameters and common-sense criteria. Numerous studies have striven to identify single predictive factors of weaning failure and sought to standardize the weaning process, but the results are characterized by remarkable heterogeneity. Despite the lack of benchmarks, it is clear that the analysis of respiratory function must include a detailed overview of the five situations described below rather than a single aspect. The purpose of this two-part review is to provide a comprehensive description of these situations to clarify the "arena" physicians are entering when weaning critically ill patients from mechanical ventilation. Publisher's NoteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach

“…14 LU allows for the clinical progress of patients admitted to the intensive care unit (ICU) to be monitored (eg, by ultrasound profiling and the LU score) and can predict the probability of successful extubation (the possibility of heart and diaphragm involvement and their ultrasound evaluation are discussed below). 18,38,39 The LU strategy also may allow for the transfer of a patient from the ICU to departments with a lower level of patient care intensity.…”

Application of bedside ultrasound in predicting the outcome of weaning from mechanical ventilation in elderly patients

“…DTF was previously explored to predict weaning from mechanical ventilation, DTF, also known as the "ejection fraction" of the diaphragm, refects active diaphragm contraction and inspiratory effort. It is associated with ICU length-of-stay, the duration of mechanical ventilation, and mortality, Ultrasonography is a widely available noninvasive tool that provides both structural and functional information about the muscle [25]. DiNino et al [3] investigated the associations between DTF at end-expiration and end-inspiration and extubation success during either SB or PS weaning trials.…”

Fatores de risco associados com falha de extubação em uma unidade de terapia intensiva de trauma

“…O resultado é consistente com outros estudos que demonstraram que uso de VMI por um período maior que 7 dias aumentou entre 4 e 7 vezes a chance de reintubação 2,4,12,21 . Ademais, assim como demonstrado previamente, episódios de reintubação podem piorar diretamente os desfechos de pacientes, independente da gravidade da doença subjacente 17,20,21,35,36,38 . Neste estudo, pacientes que exigiram reintubação apresentaram 3,3 vezes maior tempo de internação na UTI e aumento da mortalidade em aproximadamente 4 vezes.…”

“…A falha de extubação ocorre quando há a necessidade de reintubação em menos de 48 horas após a primeira tentativa de extubação 2,11 , entretanto, este critério é variável entre os estudos 2,[12][13][14] . Pacientes que falharam à extubação apresentam maiores taxas de morbimortalidade, por isso, identificar e monitorizar os fatores de risco associados à falha é importante para otimizar o desfecho clínico 1,2,[15][16][17] .…”