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Weaning Mechanical Ventilation

  • Pasquale Buonanno
  • Maria VargasEmail author
  • Giuseppe Servillo
Chapter

Abstract

Invasive mechanical ventilation is a fundamental strategy to support the respiratory function when the patient can’t bear all the work of breathing required by his clinical condition [1, 2]. Even if it represents a life-saving treatment, mechanical ventilation is associated to many complications some of which can be life-threatening: ventilator acquired pneumonia (VAP), upper airway diseases, respiratory muscle dysfunction, and atrophy [3–6]. Furthermore, it is also correlated to a prolonged length of stay in intensive care unit (ICU) and higher mortality [7].

References

  1. 1.
    Esteban A, Anzueto A, Alía I, Gordo F, Apezteguía C, Pálizas F, Cide D, Goldwaser R, Soto L, Bugedo G, Rodrigo C, Pimentel J, Raimondi G, Tobin MJ. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med. 2000;161(5):1450–8.CrossRefGoogle Scholar
  2. 2.
    Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguía C, Nightingale P, Arroliga AC, Tobin MJ, Mechanical Ventilation International Study Group. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002;287(3):345–55.CrossRefGoogle Scholar
  3. 3.
    Timsit JF, Esaied W, Neuville M, Bouadma L, Mourvllier B. Update on ventilator-associated pneumonia. F1000Res. 2017;6:2061.  https://doi.org/10.12688/f1000research.12222.1. eCollection 2017.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Dot I, Pérez-Teran P, Samper MA, Masclans JR. Diaphragm dysfunction in mechanically ventilated patients. Arch Bronconeumol. 2017;53(3):150–6.  https://doi.org/10.1016/j.arbres.2016.07.008. Epub 2016 Aug 21.CrossRefPubMedGoogle Scholar
  5. 5.
    Powers SK, Kavazis AN, Levine S. Prolonged mechanical ventilation alters diaphragmatic structure and function. Crit Care Med. 2009;37(10 Suppl):S347–53.  https://doi.org/10.1097/CCM.0b013e3181b6e760.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mendez-Tellez PA, Needham DM. Early physical rehabilitation in the ICU and ventilator liberation. Respir Care. 2012;57(10):1663–9.CrossRefGoogle Scholar
  7. 7.
    Hough CL, Caldwell ES, Cox CE, Douglas IS, Kahn JM, White DB, Seeley EJ, Bangdiwala SI, Rubenfeld GD, Angus DC, Carson SS, ProVent Investigators and the National Heart Lung and Blood Institute’s Acute Respiratory Distress Syndrome Network. Development and validation of a mortality prediction model for patients receiving 14 days of mechanical ventilation. Crit Care Med. 2015;43(11):2339–45.  https://doi.org/10.1097/CCM.0000000000001205.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Esteban A, Alía I, Ibañez J, Benito S, Tobin MJ. Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest. 1994;106(4):1188–93.CrossRefGoogle Scholar
  9. 9.
    Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997;112(1):186–92.CrossRefGoogle Scholar
  10. 10.
    Esteban A, Alía I, Gordo F, Fernández R, Solsona JF, Vallverdú I, Macías S, Allegue JM, Blanco J, Carriedo D, León M, de la Cal MA, Taboada F, Gonzalez de Velasco J, Palazón E, Carrizosa F, Tomás R, Suarez J, Goldwasser RS. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1997;156(2 Pt 1):459–65.CrossRefGoogle Scholar
  11. 11.
    Seymour CW, Martinez A, Christie JD, Fuchs BD. The outcome of extubation failure in a community hospital intensive care unit: a cohort study. Crit Care. 2004;8(5):R322–7.. Epub 2004 Jul 20.CrossRefGoogle Scholar
  12. 12.
    Goldstone J. The pulmonary physician in critical care. 10: difficult weaning. Thorax. 2002;57(11):986–91.CrossRefGoogle Scholar
  13. 13.
    Troché G, Moine P. Is the duration of mechanical ventilation predictable? Chest. 1997;112(3):745–51.CrossRefGoogle Scholar
  14. 14.
    Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, Gasparetto A, Lemaire F. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med. 1994;150(4):896–903.CrossRefGoogle Scholar
  15. 15.
    Marelich GP, Murin S, Battistella F, Inciardi J, Vierra T, Roby M. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. Chest. 2000;118(2):459–67.CrossRefGoogle Scholar
  16. 16.
    Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EF. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335(25):1864–9.CrossRefGoogle Scholar
  17. 17.
    Smyrnios NA, Connolly A, Wilson MM, Curley FJ, French CT, Heard SO, Irwin RS. Effects of a multifaceted, multidisciplinary, hospital-wide quality improvement program on weaning from mechanical ventilation. Crit Care Med. 2002;30(6):1224–30.CrossRefGoogle Scholar
  18. 18.
    Kollef MH, Shapiro SD, Silver P, St John RE, Prentice D, Sauer S, Ahrens TS, Shannon W, Baker-Clinkscale D. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med. 1997;25(4):567–74.CrossRefGoogle Scholar
  19. 19.
    MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinhorn DJ, American College of Chest Physicians; American Association for Respiratory Care; American College of Critical Care Medicine. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001;120(6 Suppl):375S–95S.CrossRefGoogle Scholar
  20. 20.
    Tobin MJ. Advances in mechanical ventilation. N Engl J Med. 2001;344(26):1986–96.CrossRefGoogle Scholar
  21. 21.
    Whelan J, Simpson SQ, Levy H. Unplanned extubation. Predictors of successful termination of mechanical ventilatory support. Chest. 1994;105(6):1808–12.CrossRefGoogle Scholar
  22. 22.
    Atkins PM, Mion LC, Mendelson W, Palmer RM, Slomka J, Franko T. Characteristics and outcomes of patients who self-extubate from ventilatory support: a case-control study. Chest. 1997;112(5):1317–23.CrossRefGoogle Scholar
  23. 23.
    Chevron V, Ménard JF, Richard JC, Girault C, Leroy J, Bonmarchand G. Unplanned extubation: risk factors of development and predictive criteria for reintubation. Crit Care Med. 1998;26(6):1049–53.CrossRefGoogle Scholar
  24. 24.
    Epstein SK, Nevins ML, Chung J. Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med. 2000;161(6):1912–6.CrossRefGoogle Scholar
  25. 25.
    Levine S, Nguyen T, Taylor N, Friscia ME, Budak MT, Rothenberg P, Zhu J, Sachdeva R, Sonnad S, Kaiser LR, Rubinstein NA, Powers SK, Shrager JB. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. 2008;358(13):1327–35.  https://doi.org/10.1056/NEJMoa070447.CrossRefPubMedGoogle Scholar
  26. 26.
    Kim WY, Lim CM. Ventilator-induced diaphragmatic dysfunction: diagnosis and role of pharmacological agents. Respir Care. 2017;62(11):1485–91.  https://doi.org/10.4187/respcare.05622. Epub 2017 Jul 11.CrossRefPubMedGoogle Scholar
  27. 27.
    De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, Cerf C, Renaud E, Mesrati F, Carlet J, Raphaël JC, Outin H, Bastuji-Garin S, Groupe de Réflexion et d’Etude des Neuromyopathies en Réanimation. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288(22):2859–67.CrossRefGoogle Scholar
  28. 28.
    Meduri GU, Schwingshackl A, Hermans G. Prolonged glucocorticoid treatment in ARDS: impact on intensive care unit-acquired weakness. Front Pediatr. 2016;4:69.  https://doi.org/10.3389/fped.2016.00069. eCollection 2016.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Christman JW, McCain RW. A sensible approach to the nutritional support of mechanically ventilated critically ill patients. Intensive Care Med. 1993;19(3):129–36.CrossRefGoogle Scholar
  30. 30.
    Richard C, Teboul JL, Archambaud F, Hebert JL, Michaut P, Auzepy P. Left ventricular function during weaning of patients with chronic obstructive pulmonary disease. Intensive Care Med. 1994;20(3):181–6.CrossRefGoogle Scholar
  31. 31.
    Farghaly S, Galal M, Hasan AA, Nafady A. Brain natriuretic peptide as a predictor of weaning from mechanical ventilation in patients with respiratory illness. Aust Crit Care. 2015;28(3):116–21.  https://doi.org/10.1016/j.aucc.2014.12.002. Epub 2015 Jan 6.CrossRefPubMedGoogle Scholar
  32. 32.
    Dres M, Teboul JL, Anguel N, Guerin L, Richard C, Monnet X. Extravascular lung water, B-type natriuretic peptide, and blood volume contraction enable diagnosis of weaning-induced pulmonary edema. Crit Care Med. 2014;42(8):1882–9.  https://doi.org/10.1097/CCM.0000000000000295.CrossRefPubMedGoogle Scholar
  33. 33.
    Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest. 2001;120(4):1262–70.CrossRefGoogle Scholar
  34. 34.
    Krishnan JA, Moore D, Robeson C, Rand CS, Fessler HE. A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation. Am J Respir Crit Care Med. 2004;169(6):673–8. Epub 2004 Jan 15.CrossRefGoogle Scholar
  35. 35.
    Sahn SA, Lakshminarayan S. Bedside criteria for discontinuation of mechanical ventilation. Chest. 1973;63(6):1002–5.CrossRefGoogle Scholar
  36. 36.
    Meade M, Guyatt G, Cook D, Griffith L, Sinuff T, Kergl C, Mancebo J, Esteban A, Epstein S. Predicting success in weaning from mechanical ventilation. Chest. 2001;120(6 Suppl):400S–24S.CrossRefGoogle Scholar
  37. 37.
    Sassoon CS, Te TT, Mahutte CK, Light RW. Airway occlusion pressure. An important indicator for successful weaning in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1987;135(1):107–13.PubMedGoogle Scholar
  38. 38.
    Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991;324(21):1445–50.CrossRefGoogle Scholar
  39. 39.
    Epstein SK. Etiology of extubation failure and the predictive value of the rapid shallow breathing index. Am J Respir Crit Care Med. 1995;152(2):545–9.CrossRefGoogle Scholar
  40. 40.
    Esteban A, Frutos F, Tobin MJ, Alía I, Solsona JF, Valverdú I, Fernández R, de la Cal MA, Benito S, Tomás R, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med. 1995;332(6):345–50.CrossRefGoogle Scholar
  41. 41.
    Keenan SP, Powers C, McCormack DG, Block G. Noninvasive positive-pressure ventilation for postextubation respiratory distress: a randomized controlled trial. JAMA. 2002;287(24):3238–44.CrossRefGoogle Scholar
  42. 42.
    Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M, Brigada P, Fracchia C, Rubini F. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann Intern Med. 1998;128(9):721–8.CrossRefGoogle Scholar
  43. 43.
    Ferrer M, Sellarés J, Valencia M, Carillo A, Gonzalez G, Badia JR, Nicolas JM, Torres A. Noninvasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomized controlled trial. Lancet. 2009;374:1082–8.CrossRefGoogle Scholar
  44. 44.
    Ouellette DR, Patel S, Girard TD, Morris PE, Schmidt GA, Truwit JD, Alhazzani W, Burns SM, Epstein SK, Esteban A, Fan E, Ferrer M, Fraser GL, Gong MN, Hough CL, Mehta S, Nanchal R, Pawlik AJ, Schweickert WD, Sessler CN, Strøm T, Kress JP. Liberation from mechanical ventilation in critically ill adults: an official American College of Chest Physicians/American Thoracic Society clinical practice guideline: inspiratory pressure augmentation during spontaneous breathing trials, protocols minimizing sedation, and noninvasive ventilation immediately after extubation. Chest. 2017;151(1):166–80.  https://doi.org/10.1016/j.chest.2016.10.036. Epub 2016 Nov 3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Pasquale Buonanno
    • 1
  • Maria Vargas
    • 1
    Email author
  • Giuseppe Servillo
    • 1
  1. 1.Department of Neurosciences, Reproductive and Odontostomatological SciencesUniversity of Naples “Federico II”NaplesItaly

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