Monitorización del destete ventilatorio en el paciente crítico

Abstract

The weaning process can be classified as simple, difficult, or prolonged. The incidence of difficult or prolonged weaning varies from 15% to 25%, according to the series. In critically ill patients it accounts for up to 50% of the total time that they are connected to the ventilator. It is very important to monitor weaning to detect the patients in whom it will be prolonged, and to help us in their management and decision making. Firstly, gas exchange and ventilatory mechanics must be monitored, fundamental in all patients on mechanical ventilation (MV). In addition, monitoring specific parameters that provide information on the patient's respiratory effort is strategic in the weaning process. These parameters include occlusion pressure (P0.1), oesophageal pressure (Poes), Negative Inspiratory Force (NIF), also known as Maximum Inspiratory Pressure (MIP), diaphragmatic electric activity (Edi), total work of breathing (WOB), and its components, elastic WOB (eWOB), and resistive WOB (rWOB). Monitoring weaning from mechanical ventilation means we can establish when the conditions have been met to start the weaning process, propose a weaning protocol adapted to the conditions of the patient, and define our post-extubation respiratory care protocol to prevent weaning failure.