Weaning in ARDS Q

Ross Freebairn

Introduction

Depending upon case mix, about one in four ventilated in an ICU has ARDS- induced respiratory failure [1]. Mechanical ventilation (MV), the mainstay of support for ARDS and also a driver of intensive care costs, is associated with complications that pose risks to patients [2, 3]. Increasing the duration of MV increases that risk [4]. As respiratory function improves, MV needs to be withdrawn at the earliest possible juncture. Very few randomized trials of MV weaning have had a primary focus on patients suffering from ARDS. For reasons outlined below, substituting results acquired from general populations or applying techniques developed in non-ARDS patient groups may have limitations.

In patients with ARDS, reversal or control of the precipitant of the respiratory failure is essential before the “weaning” can begin. This entails correction or attenuation of the precipitating cause of the ARDS as well as restoring the respiratory systems to a stable, functional state. ARDS impact is not confined to the respiratory system, and thus weaning is not solely ventilator focused. Restoration of cardiovascular, neuromuscular, neurological, and psychiatric homeostasis is required for successful weaning [5, 6].