ICU Management & Practice, Volume 19 - Issue 2, 2019
A case from a specialised weaning centre
Case
Airway and lung dysfunction
Brain dysfunction
Cardiac dysfunction
Diaphragm/respiratory muscle function
Endocrine and metabolic dysfunction
Feeding and dysphagia
Conclusion
- CHF with preserved ejection fraction (diastolic dysfunction)
- Acute-on-chronic kidney failure
- Difficult to treat hypertension due to renal artery stenosis
- o Leading altogether to peripheral and lung oedema
- No angiographic/surgical intervention due to severe atherosclerosis with increased risk of complications
- Intensive fluid removal with haemodialysis (total negative fluid balance 9.6 L)
- Nitroglycerin during SBT (systolic blood pressure < 150 mmHg) to prevent CHF due to increased afterload
- Treatment of hypertension with AT2 antagonist
- Our patient could be successfully weaned from the ventilator and extubated within 4 days.
Key points
- Factors increasing the work of breathing and thereby contributing to weaning failure, are increased airway resistance, decreased lung or chest wall compliance and impaired gas exchange.
- Brain dysfunction is associated with a higher risk of failed extubation and anxiety, sleep disturbances and depression may interfere with successful weaning.
- During mechanical ventilation respiratory muscle dysfunction rapidly develops and is associated with difficult weaning, but not with peripheral muscle weakness.
- Adrenal insufficiency and hypothyroidism have been described as possible reasons for weaning failure accompanied by successful treatments.
- Malnutrition frequently occurs in critically ill patients and is associated with higher mortality and reduced muscle mass contributing to difficult weaning.
- An individualised structural evaluation of weaning failure helps to find the underlying causes of weaning failure and to prescribe an individualised treatment plan.
References:
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