Table 3 Factors that can lead to weaning failure due to the imbalance between ventilatory needs and respiratory capacity
Factors that increase the load | ||
|---|---|---|
Increased resistive loads | Increased chest wall elastic loads | Increased lung elastic loads |
Bronchospasm | Pleural effusion | Hyperinflation (intrinsic positive end-expiratory pressure) |
Airway edema, secretions | Pneumothorax | Alveolar oedema |
Upper airway obstruction | Flail chest | Infection |
Obstructive sleep apnea | Obesity | Atelectasis |
Endotracheal tube kinking | Ascites | Interstitial inflammation and/or oedema |
Secretions encrustation | Abdominal distension | |
Ventilatory circuit resistance | ||
Factors that result in decreased neuromuscularcompetence | ||
Decreased drive | Muscle weakness | Impaired neuromuscular transmission |
Drug overdose | Electrolyte derangement | Critical illness polyneuropathy |
Brain-stem lesion | Malnutrition | Neuromuscular blockers |
Sleep deprivation | Myopathy | Aminoglycosides |
Hypothyroidism | Hyperinflation | Guillain-Barré syndrome |
Starvation/malnutrition | Drugs, corticosteroids | Mysthenia gravis |
Metabolic alkalosis | Sepsis | Phrenic nerve injury |
Myotonic dystrophy | Spinal cord lesion | |