The Difficult-to-wean Patient

Nicolino Ambrosino; Luciano Gabbrielli


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

In This Article

Causes of Prolonged MV

The most frequent cause of prolonged MV is a severe acute condition over a severe chronic disease.[2] Several pathophysiological factors can lead to prolonged weaning as described in Box 1.[8,13,15–17]

Careful research of potentially reversible pathologies should be conducted in all patients who do not succeed in simple weaning. The pathophysiologic mechanisms leading to weaning failure in this group may be complex and multifactorial, with several potentially reversible etiologies for weaning failure, including: respiratory and/or cardiac load; neuromuscular competence (central and peripheral); critical illness neuromuscular abnormalities; neuropsychological factors; and metabolic and endocrine disorders (Box 1). These factors should be considered in patients requiring MV for more than 7 days.

In this group of chronically critically ill patients, there is the need for a comprehensive approach to ongoing surveillance for any reversible or irreversible factors.[13] Since long-term MV is usually prescribed in end-stage respiratory diseases with poor nutritional status, nutrition and dietary intake-related problems need to be carefully assessed and corrected in these patients.[18]


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