Journal of Acute Care

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VOLUME 2 , ISSUE 1 ( January-April, 2023 ) > List of Articles


Difficult Weaning in ICU

Raghunath Aladakatti, Aishwarya Sadashivamurthy

Keywords : Breathing Trial, Difficult extubation, Difficult weaning, Intensive care unit mortality, Spontaneous, Weaning, Weaning failure

Citation Information : Aladakatti R, Sadashivamurthy A. Difficult Weaning in ICU. 2023; 2 (1):10-14.

DOI: 10.5005/jp-journals-10089-0062

License: CC BY-NC 4.0

Published Online: 23-08-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Weaning or discontinuation of mechanical ventilation can be defined as the process of gradual or sudden ventilatory support withdrawal in critically ill patients. Weaning failure is defined as either failure of spontaneous breathing trial (SBT) or the need for reintubation within 48 hours following extubation. It is estimated that 40% of the time, the patient who has been intubated and ventilated will be dedicated to the process of weaning. Almost 50% of these patients did not require reintubation, suggesting that ventilation was unnecessarily prolonged. This delay in weaning will cause an increase in the length of intensive care unit (ICU) stay, length of hospital stay, number of ventilatory days, overall cost of care, and increased mortality. Delay in weaning can be a risk for ventilator-induced lung injury, hospital-acquired infection, especially ventilator-associated pneumonia, airway trauma due to the endotracheal tube, and prolonged sedation with its complications. On the other hand, early weaning or extubation can cause respiratory muscle fatigue and risk of reintubation. When the patient enters into difficult or prolonged weaning, there is also a risk of need for tracheostomy as well as an increase in mortality. Earlier, clinicians used to try SBTs for a longer duration, which adversely affected the weaning process as patients had to breathe with minimal support or without support against increased respiratory load. However, while weaning, most of the weaning failures can be identified within 30 minutes. Early identification for the readiness of weaning using weaning criteria and initiating SBT with pressure support 5–8 cm H2O, continuous positive airway pressure (CPAP) of 5 cm H2O is advisable. In patients at high risk for extubation failure, extubation to noninvasive preventive ventilation is suggested. Early physical and occupational therapy is safe and well tolerated, resulting in better functional outcomes.

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