Acute Respiratory Failure and Pulmonary Complications in End-Stage Liver Disease

Nida Qadir, MD; Tisha Wang, MD; Igor Barjaktarevic, MD, PhD; Steven Y. Chang, MD, PhD


Semin Respir Crit Care Med. 2018;39(5):546-555. 

In This Article

Discontinuing Mechanical Ventilation

Daily assessments for readiness for discontinuing mechanical ventilation should be performed with protocolized interruptions of sedatives and spontaneous breathing trials (SBTs). The use of daily sedation interruption and SBTs has been shown to increase ventilator- and ICU-free days, as well as 1-year survival.[105,106]

Patients who are extubated often remain at risk for respiratory failure and some require reintubation. The use of HFNC oxygen for 24 hours following extubation is a minimal-risk intervention that has been shown to decrease rates of reintubation compared with conventional oxygen therapy.[107] Its use may be particularly beneficial in the vulnerable ESLD population. The use of NIPPV immediately after extubation has also been associated with reduced rates of reintubation in patients thought to be at high risk prior to extubation.[108] However, multiple contraindications to NIPPV exist, many of which are common in ESLD patients, including altered mental status, shock, and multiorgan failure. Additionally, HFNC has been demonstrated to be noninferior to NIPPV for preventing reintubation in high-risk patients, and is likely to be a more practical choice in the majority of critically ill ESLD patients.[109]