Differenzialdiagnose und Management von Weaningproblemen

Abstract

Of 6 ventilated ICU patients, 1 patient will experience prolonged weaning from mechanical ventilation. This is associated with a substantially increased morbidity and mortality. After one unsuccessful spontaneous breathing trial, the organ system preventing successful weaning should be identified. The mechanisms limiting weaning should be assessed toward the end of a failing spontaneous breathing trial using physical examination, arterial and venous blood gases, echocardiography, and other tools. Disturbed mechanics of the respiratory system, weakness of the ventilatory muscles, and weaning-induced cardiac dysfunction including myocardial ischemia are common causes of difficult or prolonged weaning. The respective therapeutic strategies are reduction of the work of breathing, ventilatory muscle training, and reducing cardiac preload as well as afterload. Weaning problems are preventable by a structured weaning strategy, including early spontaneous awakening and breathing trials as well as early rehabilitation of patients with ICU-acquired weakness. © 2011 Springer-Verlag.