Page 553 - Clinical Application of Mechanical Ventilation

Weaning from Mechanical Ventilation 519

ventilation (.72 hours), and upper airway disorders are some key factors that affect
the weaning outcome (Boles et al., 2007).
Impact of Weaning Failure. It is obvious that patients who require prolonged venti-
lator support have a severe impact on the use of health care resources, including
financial, physical, and human resources. In addition, the longer a patient stays on
the ventilator, emotional and psychological pains also take a toll. For these reasons,
different strategies have been devised to enhance the weaning process. These strate-
gies are designed to minimize the use of limited resources, and to keep the patients
from the uncomfortable and sometimes painful diagnostic and therapeutic proce-
dures associated with mechanical ventilation.

PATIENT CONDITION PRIOR TO WEANING

Perhaps the first consideration before any weaning attempt is to assess the patient’s
Before weaning, the overall clinical status. Two important questions pertaining to the patient’s clinical
patient should have recovered condition are (1) Has the patient significantly recovered from the acute phase of the
from the acute phase of the
disease leading to mechanical disease or injury that prompted the need for mechanical ventilation? (2) Are there
ventilation and be able to as- other clinical conditions that may interfere with the patient’s ability to sustain the
sume adequate spontaneous
breathing. work of spontaneous breathing?
Assessment of the patient’s overall clinical condition should include an evaluation
of the clinical conditions in Table 16-1. Depending on the severity of these clinical
conditions, they should be corrected or normalized prior to a weaning attempt.

TABLE 16-1 Conditions That May Hinder a Successful Weaning Outcome

Condition Example

Patient/pathophysiologic Fever
Infection
Renal failure
Sepsis
Sleep deprivation
Cardiac/circulatory Arrhythmias
Blood pressure (high or low)
Cardiac output (high or low)
Fluid imbalance
Anemia
Dysfunctional hemoglobins

Dietary/acid-base/electrolytes Nutritional or caloric deficit
Acid-base imbalance
Electrolytes imbalance
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