The Difficult-to-wean Patient

Authors and Disclosures

Nicolino Ambrosino^†1,2 and Luciano Gabbrielli<sup>1

1</sup>Cardiothoracic Department, Pulmonary Unit, University Hospital of Pisa, Via Paradisa 2, Cisanello, Pisa, Italy
²Weaning and Pulmonary Rehabilitation Unit, Auxilium Vitae, Volterra, Italy

^†Author for correspondence
Tel.: +39 050 996 786 Fax: +39 050 996 779 n.ambrosino@ao-pisa.toscana.it

Sidebar

Key issues

• Patients admitted to intensive care units requiring mechanical ventilation may suffer from difficult weaning.

• Reversible causes for weaning failure may be: respiratory and/or cardiac load, neuromuscular abnormalities, neuropsychological factors, and metabolic and endocrine disorders.

• As a consequence of weaning failure, patients may undergo need for prolonged ventilator dependence, a component of the 'chronic respiratory illness'.

• These difficult-to-wean patients may be managed in two type of units: respiratory intermediate-care units and specialized regional weaning centers.

• Usually two weaning protocols are used: progressive reduction of ventilator support, or progressively longer periods of spontaneous breathing trials.

• Physiotherapy is an important component of weaning protocols.

• Studies report great variability in the clinical outcomes of weaning protocols.

• The decision to perform tracheostomy should be made with caution, and efforts should be made to identify patients who might clearly benefit from this technique to avoid unnecessary and unwanted prolonged mechanical ventilation.