Overview: Weaning is a gradual reduction of mechanical ventilation. In some cases, this process is rapid and uneventful and for some patients, the process may be prolonged for days or weeks. Weaning is a term that is used in two separate ways: discontinuation of mechanical ventilation and removal of any artificial airway. Once a patient can sustain spontaneous breathing, a second decision should be made whether the artificial airway can be removed. This decision is made based on the patient’s mental status, airway protective mechanisms, ability to cough, and type of secretions. Weaning procedures are usually initiated only after the underlying disease process that required mechanical ventilation has significantly improved or is resolved. When to wean the patients Normalized inspiratory to expiratory (I:E) ratio Reducing fraction of inspired oxygen ratio (usually <0.5) No requirement for high positive end-expiratory pressure (PEEP) Appropriate underlying respiratory rate Appropriate tidal volume with moderate airway pressures Brief of case study: A critical patient was on mechanical ventilation. Treatment given: After two days of mechanical ventilation at a TV of 400 with a respiratory rate of 14. Initially, the PEEP of 8 was converted to 6. Later, the patient was given a T-piece trial for weaning. After treatment: During the transition from mechanical ventilation (associated with removal of PEEP) patient started manifesting signs of pulmonary edema respiratory distress drop in saturation tachycardia with bilateral crackles Discussion Removal of the ventilator (or PEEP) usually causes bradycardia. Conversion of positive pressure ventilation to negative pressure ventilation can cause atrial stretch due to an increase in the venous return resulting in autonomic signaling and bradycardia. If the patient gets tachycardia during weaning this can be categorized as failed weaning (especially if this was accompanied by high blood pressure or tachypnoea) and evaluating the cause is very important. A gradual…
A case study of weaning in a patient with mechanical ventilationOctober 26, 2021 | 0 Comment
Dr. Sanjith Saseedharan
MBBS, Diploma in Anesthesiology
Head, Department of Intensive Care Unit, S.L. Raheja Hospital (A Fortis Associate), Mumbai, Maharashtra, India.