Psychological Dysfunction

Forty-two percent of patients weaning from prolonged MV have depression, and weaning failure is twice as common in patients with depression [97, 98]. Fatigue, excessive daytime somnolence, and associated depression also delay weaning [99].

Second-generation antipsychotic and stimulants such as donepezil, modafinil, and methylphenidate have been used in difficult-to-wean patient depression [99- ЮЗ]. Whether their effect is through counteracting depression or anxiety or as a direct respiratory stimulus is unclear.

Up to 80% of patients in ICU have delirium and are associated with delayed weaning and higher 6-month mortality [72, 104]. Prevention strategies include an early and exercise/mobility. Patients exposed to an “ABCDE” bundle spent 3 more days breathing without assistance and experienced nearly half the delirium, than patients treated with usual care [77]. Haloperidol is most commonly used for ICU delirium although evidence is entirely anecdotal [72]. Dexmedetomidine is also recommended [105]. Olanzapine, risperidone, and quetiapine are also used and may have some advantages in the critically ill [72].