Management of the Difficult Weaning from Mechanical Ventilation

Abstract

Up to 40% of patients admitted to intensive care units may require mechanical ventilation due to acute respiratory failure or acute on chronic respiratory failure and this need is increasing. There is evidence that 20% of patients will need prolonged ICU length of stay due to difficult weaning. Weaning critically patients from mechanical ventilation is gradual and challenging process. Prolonged mechanical ventilation is defined as the need for mechanical ventilation for in excess of 21 days and for 6 or more hours per day. There are many causes for difficult weaning from mechanical ventilation like systemic causes which include chronic disorders and metabolic and nutritional disturbance. Respiratory causes include unresolved reparatory failure, imbalance between WOB and respiratory muscles capacity and upper airway obstruction. Cardiac causes include left ventricular dysfunction, cardiomyopathy and myocardial ischemia.