The Difficult-to-wean Patient

Nicolino Ambrosino; Luciano Gabbrielli


Expert Rev Resp Med. 2010;4(5):685-692. 

In This Article

Definition of Difficult-to-wean Patient

Patients who need prolonged MV have high resource utilization and relatively poor outcomes, especially the elderly, and are increasing in number.[6] The most recent data suggest that the global prevalence of ventilator-assisted individuals in Europe ranges from two to 30 per 100,000 population in different countries.[7] Difficult-to-wean patients have been variously defined.[8–12] According to the European Respiratory Society (ERS) Task Force, difficult-to-wean patients are those requiring more than 7 days of weaning after the first spontaneous breathing trial (SBT; prolonged weaning).[13] These patients may represent up to 14% of patients admitted to the ICU for intubation and MV and are associated with a in-hospital mortality of up to 32%.[14] The National Association for Medical Direction of Respiratory Care Consensus Conference defined prolonged MV as the need for more than 21 consecutive days of MV for more than 6 h a day.[8] There is evidence that 3–7% of patients fulfill this definition.[12] Some authors suggest that placement of a tracheotomy after at least 10 days of MV defines the onset of prolonged weaning because this definition involves the concept that the patient is not expected to die or to wean from the ventilator in the immediate future.[5]


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