Weaning Failure

This aspect of management is considered in the chapter by Goldstone. Weaning protocols51 may be helpful, principally by identifying patients who no longer require ventilatory support. COPD accounts for approximately 25% of weaning failures, defined as those still ventilator dependent 3 weeks or more after recovery from the condition precipitating ICU admission.3-5 The negative aspects of a continued stay in the modern ICU environment, especially when only single organ (respiratory) failure persists, justifies considering referral to specialist weaning centres4 5 which may be regionally provided in the future. On the other hand, sensitivity to the wishes of patients and/or judicious withholding of an escalation in therapy when deterioration occurs is also good practice in the irreversibly ventilator dependent patient.14

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