ICU Cases · Advanced respiratory support
The difficult-to-wean patient
A short case on the difficult-to-wean patient — the systematic search for the causes (the cardiac, the electrolyte, the sedation, the weakness, the secretions), and the NIV-facilitated extubation strategy.
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Prompt
A 72-year-old woman has failed three spontaneous breathing trials over two weeks on the ventilator. Discuss the approach to the difficult-to-wean.
Presentation
A 72-year-old woman with the COPD and the cardiac failure has been ventilated for 10 days for a pneumonia. She has failed three spontaneous breathing trials — each time with a rising respiratory rate, a tachycardia and a diaphoresis within 30 minutes of the 5 cmH2O trial. The team asks for the approach.
References2ShowHide
- [1]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [2]Burns KEA, Stevenson J, Laird M, et al. Non-invasive ventilation versus invasive weaning in critically ill adults. Thorax, 2022.PMID 34716282