Weaning mechanical ventilation

Abstract

Obstructive sleep apnea (OSA), a frequently undiagnosed disease, is common among patients admitted to ICU with respiratory failure and requiring mechanical ventilation. Patients with OSA present a unique set of problems due to changes in respiratory mechanics. Sleep disordered breathing (SDB) may play a significant role while weaning these patients from mechanical ventilation; OSA can manifest as recurrent hypoxia and hypoventilation causing failure of weaning and prolonged mechanical ventilation. Use of sedatives and neuromuscular blockade may further complicate weaning process due to aggravation of OSA. Hence, it is important to have a high risk of suspicion of OSA, especially in patients who are facing difficulty in weaning. The general principle of weaning of these patients remains same with certain modifications to accommodate the physiological changes due to OSA. Daily assessment for readiness to wean, spontaneous breathing trial (SBT) when deemed fit to wean, and extubation on successful SBT followed by extubation to NIV may be the best strategy.