Figure 1
From: Clinical review: The ABC of weaning failure - a structured approach
Framework for the evaluation of difficult-to-wean patients. For each patient, diagnostics as described in the white box should be performed to assess the reasons(s) for difficult weaning. Endocrine dysfunction is probably relatively rare and therefore is not included in the first line of evaluation. Possible treatment/interventions are mentioned but, of course, need to be individualized. If the first-line evaluation does not improve weaning, proceed to the next level (within the affected column). For instance, if airway resistance is elevated but is not affected by albuterol and optimizing ventilator settings, diagnostic bronchoscopy should be performed to visualize the central airways. Risks and benefits should be weighed in each patient. ACTH, adrenocorticotrophic hormone; BNP, brain natriuretcic peptide; CAM-ICU, confusion assessment method for the intensive care unit; DO2, oxygen delivery; ECG, electrocardiogram; EIC, end inspiratory cycling; EMG, electromyography; iv, intravenous; P0.1, airway occlusion pressure at 100 ms; PEEPi, intrinsic positive end-expiratory pressure; Pi, inspiratory pressure; PSV, pressure support ventilation; SBT, spontaneous-breathing trial; SvO2, mixed venous oxygen saturation.