ASSESSMENT OF PATIENTS READINESS FOR WEANING FROM THE RESPIRATOR AFTER MECHANICAL LUNG VENTILATION

Abstract

Introduction. Approximately 20% of patients on mechanical lung ventilation (MLA) experience weaning difficulties. It is recommended to evaluate objective clinical criteria used to predict a patient's readiness of weaning from a respirator. Randomized trials have shown the effectiveness and safety of the spontaneous breathing test (SBT) with inspiratory pressure support as a weaning method. Currently, there are many predictors of ventilator weaning, including both clinical and sonographic criteria, such as rapid shallow breathing index (RSBI), diaphragm thickening fraction (DTf), and Diaphragmatic excursion (DE). Case description. Patient K., 87 years old, has a history of 3 acute ischemic strokes with signs of vascular dementia according to relatives. 3 weeks ago, she hit her head at home and lost consciousness. She was hospitalized in a medical institution, after drainage of subdural hematomas, she was under analgosedation. 26 hours after tracheal intubation, in the presence of clinical criteria, a SBT was performed with calculation of RSBI, DTf and DE. After evaluating the predictors of weaning from the respirator, a decision was made to extubate the patient. After weaning from the respirator, the general condition is satisfactory. Conclusions. Assessment of predictors of successful ventilator weaning is relevant in elderly patients with dementia, when assessment of mental status is difficult and the use of objective indicators helps in decision-making regarding ventilator weaning.