title: The differential diagnosis for failure to wean from mechanical ventilation.
abstract: OBJECTIVE
  In this review, we discuss the causes for a failed weaning trial and specific diagnostic tests that could be conducted to identify the cause for weaning failure. We briefly highlight treatment strategies that may enhance the chance of weaning success.
  
  
  RESULTS
  Impaired respiratory mechanics, respiratory muscle dysfunction, cardiac dysfunction, cognitive dysfunction, and metabolic disorders are recognized causes for weaning failure. In addition, iatrogenic factors may be at play. Most studies have focused on respiratory muscle dysfunction and cardiac dysfunction. Recent studies demonstrate that both ultrasound and electromyography are valuable tools to evaluate respiratory muscle function in ventilated patients. Sophisticated ultrasound techniques and biomarkers such as B-type natriuretic peptide, are valuable tools to identify cardiac dysfunction as a cause for weaning failure. Once a cause for weaning failure has been identified specific treatment should be instituted. Concerning treatment, both strength training and endurance training should be considered for patients with respiratory muscle weakness. Inotropes and vasodilators should be considered in case of heart failure.
  
  
  CONCLUSIONS
  Understanding the complex pathophysiology of weaning failure in combination with a systematic diagnostic approach allows identification of the primary cause of weaning failure. This will help the clinician to choose a specific treatment strategy and therefore may fasten liberation from mechanical ventilation.
authors: Department of Critical Care Medicine, Radboud University Nijmegen Medical Center, The Netherlands.
authors: Jonne
authors: J
authors: Doorduin
authors: Johannes G
authors: JG
authors: van der Hoeven
authors: Leo M A
authors: LM
authors: Heunks
mesh_terms: D000403:Airway Resistance / Q000187:drug effects; D001993:Bronchodilator Agents / Q000627:therapeutic use; D060825:Cognitive Dysfunction / Q000139:chemically induced; D016638:Critical Illness / Q000628:therapy; D003937:Diagnosis, Differential; D004700:Endocrine System Diseases / Q000150:complications / Q000628:therapy; D006321:Heart / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D020249:Hormone Replacement Therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D008170:Lung Compliance; D008659:Metabolic Diseases / Q000150:complications / Q000628:therapy; D012123:Pulmonary Ventilation; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012132:Respiratory Muscles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D013315:Stress, Psychological / Q000150:complications; D045165:Testosterone Congeners / Q000627:therapeutic use; D017211:Treatment Failure; D014665:Vasodilator Agents / Q000627:therapeutic use; D015300:Ventilator Weaning
chemical_list: D001993:Bronchodilator Agents; D006993:Hypnotics and Sedatives; D045165:Testosterone Congeners; D014665:Vasodilator Agents