Difficulties of weaning from prolonged mechanical ventilation

M. Negrău, L. Szegedi, M. Galu, Călina Constande
Catedra Anestezie-Terapie Intensivă şi Urgenţă Prespitalicească – Facultatea de Medicină, Universitatea Oradea

Abstract

Aims. Long term mechanical ventilation creates a patient dependency on the ventilator, which becomes obvious at the attempts of weaning. In this paper we tried to reveal the difficulties that can appear during the weaning of the patients with prolongued mechanical ventilation.

Materials and methods. We selected 17 patients, divided into two groups by pathology, as follows: a first group of 7 patients with neuromuscular disease, and a second group of 10 patients with superimposed infection on COPD. All the patients necessitated mechanical ventilation with IPPV for more than 16 days. The attempts to discontinue the mechanical ventilation were made according to the weaning criteria, and the termination of the weaning was also based on objective criteria. Also the duration of mechanical ventilation, the duration of the weaning period, the number of weaning attempts and the appearance of the complications of mechanical ventilation was recorded.

Results. Most of the patients necessitated more then one attempt for a successful weaning, over a period of several days, regardless of the initial pathology. Although in the patients with neuromuscular diseases the duration of the mechanical ventilation and the duration of weaning were longer, the incidence of pulmonary complications were lower, in comparison with the patients from COPD group.

Conclusions. For all patients with long term mechanical ventilation, the weaning process is difficult, and the use of the weaning criteria does not guarantee its success. The incidence of the complications depends more on the underlying pathologic condition initially requiring mechanical ventilation, rather than on the duration of the ventilator support.

Key words: mechanical ventilation, weaning, neuromuscular diseases, COPD

Dificultăţi în întreruperea ventilaţiei mecanice prelungite

Jurnalul Român de Anestezie Terapie intensivă 2004 Vol.11 Nr.1, 39-43