Factors associated with weaning failure

Failure to wean is associated with:

• Increased oxygen cost of breathing

• Muscle fatigue (hypophosphataemia, hypomagnesaemia, hypokalaemia, malnutrition, peripheral neuropathy, myopathy and drugs, e.g. muscle relaxants, aminoglycosides)

• Inadequate respiratory drive (alkalosis, opiates, sedatives, malnutrition, cerebrovascular accident, coma)

• Inadequate cardiac reserve and heart failure

In the latter case cardiac function should be monitored during spontaneous breathing periods. Any deterioration in cardiac function should be treated aggressively (e.g. optimal fluid therapy, vasodilators, inotropes).

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