Withdrawal of mechanical ventilation

The course of respiratory failure related to neuromuscular disease is extremely variable. Numerous factors such as the primary diagnosis, chronic health status, treatment, and the presence or absence of supervening complications dictate the rate of recovery. Attempts to wean the patient from mechanical ventilation are unlikely to be successful until the vital capacity is greater than 7 ml/kg, and should only proceed if the patient is stable in other respects. The most commonly used weaning techniques are to place the patient on slowly decreasing levels of pressure support, or to allow them to breathe through a T-piece for increasing periods of time, returning them to the pressure support mode in between the periods. Irrespective of the strategy chosen, a low level of pressure support (10 cmH2O) is maintained overnight to allow the patient to rest and avoid nocturnal hypoxaemia. Synchronised intermittent mandatory ventilation (SIMV) should not be used once the patient is able to trigger the ventilator, as it prolongs the duration of mechanical ventilation.93

Many patients find that this period of ventilator withdrawal provokes extreme anxiety because of psychological dependence on the presence and the sound of the ventilator. Careful assessment of respiratory function and extensive psychological support are required to meet the physical and emotional needs of the patient at this stage.

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