Withdrawal of Mechanical Ventilation in Neurosurgical Critical Care
Withdrawal of mechanical ventilation in the Neuro ICU should proceed in a careful, coordinated fashion. The trajectory of each individual patient will depend upon their ventilatory capacity and respiratory drive, and the likelihood of upper airway obstruction upon extubation. Patients with near apnea will die within minutes. Those with good ventilatory capacity will sustain their breathing without mechanical ventilation, prompting a subsequent discussion about maintaining life through artificial feeding. Those with impaired ventilation will require aggressive, proactive use of medication to blunt dyspnea. Opioids are the drug of choice and should be administered in anticipation of expected dyspnea. Attention to family preferences and clinician presence at the bedside are paramount.