oa Southern African Journal of Critical Care - There’s more to weaning than just the lungs! - editorial

Volume 34 Number 2
  • ISSN : 1562-8264
  • E-ISSN: 2078-676X



Although life-sustaining, mechanical ventilation is associated with complications that can impact on mortality and morbidity. Therefore, weaning is initiated early during the course of mechanical ventilation, with the aim of liberation as soon as possible. In some cases, patients can be weaned quickly from mechanical ventilation, while others may take significantly longer, regardless of whether there are protocols or not. Extubation failure is associated with longer periods of mechanical ventilation, longer hospital stays and increased mortality. There are numerous measures and indices that have been developed to determine weaning and extubation suitability; however, the accuracy of these indices is yet to be convincingly and consistently shown. Of note, muscle strength and endurance have not been assessed as factors in any of the identified studies for weaning/extubation success, but both impact on weaning. One of the reasons for the lack of accuracy of weaning indices may be that the majority of these indices are derived from ventilatory parameters. Cardiovascular dysfunction prior to or during weaning is being increasingly recognised as a contributor to weaning failure. Consciousness and psychological factors such as delirium, depression and anxiety have also been shown to affect weaning outcome. Nutrition and the underlying physiological status of the patient are also factors to consider.[2] Furthermore, muscle weakness of both respiratory and peripheral muscles has also been associated with weaning failure. Many of the aforementioned factors may be ameliorated through rehabilitative interventions during the course of mechanical ventilation.

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