A case study of a patient with weaning-induced pulmonary oedema

Overview: Weaning from mechanical ventilation is an important and universal factor in the care of critically ill intubated patients receiving mechanical ventilation. Weaning covers the entire process of liberating the patient from mechanical support and the endotracheal tube, along with significant aspects of terminal care. In critically ill patients, weaning-induced pulmonary oedema (WiPO) was responsible for 59 % of weaning failures.1 Earlier COPD, cardiopathy, and, to some extent, obesity, were independent risk factors for WiPO. Also, myocardial ischemia, excessive increased LV afterload, and increased cardiac preload play major contributing roles. Brief of the case study: A critical patient was on mechanical ventilation and was later weaned. Diagnosis: Weaning associated pulmonary edema Treatment given: The doctor decided to ventilate this patient completely for 24 hours because of weaning failure while maximizing medical management. Discussion: 24-hour mechanical ventilation should be followed by a gradual change to pressure support with PEEP as it would help wean this patient. The weaning trial must be well monitored as it is extremely important to return the patient to full ventilator support and try to prevent further respiratory fatigue. Failure to do so may increase the possibility that future attempts might fail. It was observed in one study among healthy volunteers that if the muscle were worked up to exhaustion by making them breathe through an expiratory resistance of 60% of maximal the magnetic twitch transdiaphragmatic pressure is markedly reduced for 24 hours.2 Therefore, at this stage, the practice of progressive reductions of pressure support levels while maintaining 5 to 8 cm H2O of PEEP could be an appealing option as pressure support is supposed to increase LV afterload less than spontaneous breathing. Also, direct extubation to non-invasive ventilation in suitable patients could be attempted. References: Liu J, Shen F, Teboul JL, et al. Cardiac dysfunction induced…

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