Ventilator Weaning in Prolonged Mechanical Ventilation—A Narrative Review

Abstract

Patients requiring mechanical ventilation (MV) beyond 21 days, usually referred to as prolonged MV, represent a unique group with significant medical needs and a generally poor prognosis. Research suggests that approximately 10% of all MV patients will need prolonged ventilatory care, and that number will continue to rise. Although we have extensive knowledge of MV in the acute care setting, less is known about care in the post-ICU setting. More than 50% of patients who were deemed unweanable in the ICU will be liberated from MV in the post-acute setting. Prolonged MV also presents a challenge in care for medically complex, elderly, socioeconomically disadvantaged and marginalized individuals, usually at the end of their life. Patients and their families often rely on ventilator weaning facilities and skilled nursing homes for the continuation of care, but home ventilation is becoming more common. The focus of this review is to discuss recent advances in the weaning strategies in prolonged MV, present their outcomes and provide insight into the complexity of care.

The Value of Ischemic Cardiac Biomarkers to Predict Spontaneous Breathing Trial or Extubation Failure: A Systematic Review

“…Weaning failure is therefore often regarded as a composite of both SBT and extubation failure. SBT failure is defined as the inability to successfully tolerate spontaneous breathing with minimal support by PEEP and/or pressure support or via a T-piece for 30–120 min [ 7 , 8 ]. Extubation failure is defined as the need for reintubation within 48–72 h [ 9 , 10 ] or up to 7 days after extubation [ 11 , 12 ].…”