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Chapter 14 - Weaning from Mechanical Ventilation in Neurological Patients

Published online by Cambridge University Press:  26 May 2025

By
Jens D. Rollnik
Edited by
Martin Groß ,
Eelco F. M. Wijdicks ,
Maxwell S. Damian  and
Oliver Summ
Martin Groß
Affiliation:
MEDIAN Clinic Bad Tennstedt
Eelco F. M. Wijdicks
Affiliation:
Mayo Clinic
Maxwell S. Damian
Affiliation:
Basildon University Hospitals
Oliver Summ
Affiliation:
Evangelisches Krankenhaus Oldenburg
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Summary

Long-term or prolonged mechanical ventilation is a challenge facing many neurological intensive care patients. Weaning these patients from the respirator in Germany and Switzerland increasingly takes place in weaning centers specialized in early neurological-neurosurgical rehabilitation or paraplegiology, combining intensive care and rehabilitation. Prolonged or difficult weaning refers to at least three failed spontaneous breathing trials (SBTs) or mechanical ventilation of more than seven days after the first unsuccessful SBT. Neurological intensive care patients have a high burden of morbidity with disorders of consciousness and poor functional status. Often they depend on kidney replacement therapies and are colonized with multidrug resistant bacteria, In the chapter, we discuss predictors of weaning success, therapeutic interventions in mechanically ventilated neurological patient (such as physiotherapy, occupational therapy, basal stimulation, speech/swallowing therapy, psychological support and respiratory therapy), weaning strategies and home ventilation. Practical recommendations for management are provided.

Keywords

mechanical ventilationdifficult weaningearly neurological-neurosurgical rehabilitation (ENNR)spontaneous breathing trialsrespiratory therapyweaning strategieshome ventilation

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Type
Chapter
Information
Clinical Neurorespiratory Medicine , pp. 159 - 167
Publisher: Cambridge University Press
Print publication year: 2025

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References

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