Mechanical ventilation weaning from

The use of acetazolamide in the presence of unrecognized cerebral edema due to fat embolism, with sudden normalization of brain C02, as occurred in this patient when her previous state of hypocapnia was no longer sustained by ventilatory effort, resulted in cerebral acidosis, vasodilatation, and a further increase in intracranial pressure. This proved catastrophic and led to brainstem herniation and brain death. Acetazolamide should be avoided if at all possible in patients with bony and traumatic brain injuries, particularly during weaning from mechanical ventilation, since it can precipitate coning in patients with raised intracranial pressure. 

The safety and efficacy of nalbuphine, with respect to the treatment of pediatric pain, have not been fully established. For patients older than 1 year of age, doses of 0.1-0.2 mg/kg SQ/IM/IV every 3-4 hours are utilized, and individualized, as above [6]. The maximum dose is 20 mg/administration and the daily total dose should not exceed 160 mg. Nalbuphine, in doses of 0.05-0.1 mg/kg SQ/IM/IV, has been used to facilitate weaning from mechanical ventilation in the pediatric intensive care unit setting. Nalbuphine is also used to relieve pruritus, caused by narcotic administration, in this population as well as in adults. 

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Meade M, Guyatt G, Cook D, et al. Predicting success in weaning from mechanical ventilation. 

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Vallverdu I, Calaf N, Subrrana M, et al. Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med 1998 158(6) 1855-1862. 

Scheinhorn DJ, Chao DC, Hassenpflug MS, et al. Post-lCU weaning from mechanical ventilation the role of long-term facilities. Chest 2001 120(6 suppl) 482S 84S. 

Scheinhorn D, Hassenpflug M, Votto J, et al. Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation. Chest 2007 131(l) 76-84. 

Chao DC, Scheinhom DJ, Steam-Hassenpflug M. Impact of renal dysfunction on weaning from prolonged mechanical ventilation. Crit Care (Lond) 1997 1(3) 101-104. 

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Nevins ML, Epstein SK. Weaning from prolonged mechanical ventilation. Clin Chest Med 2001 22(l) 13-33. 

Morganroth ML, Moiganroth JL, Nett LM, et al. Criteria Jot weaning from prolonged mechanical ventilation. Arch Intern Med 1984 144(5) 1012-1016. 

Vieira JM Jr., Castro I, Curvello-Neto A, et al. Effect of acute kidney injury on weaning from mechanical ventilation in critically ill patients. Crit Care Med 2007 35(1) 184—191. 

De Jonghe B, Bastuji-Garin S, Sharshar T, et al. Does ICU-acquired paresis lengthen weaning from mechanical ventilation. Intensive Care Med 2004 3(X6) 1117-1121. 

Aldrich TK, Karpel JP, Uhrlass RM, et al. Weaning from mechanical ventilation adjunctive use of inspiratory muscle resistive training. Crit Care Med 1989 17(2) 143-147. 

Hurford WE, Favorito F. Association of myocardial ischemia with failure to wean from mechanical ventilation. Crit Care Med 1995 23(9) 1475-1480. 

Nozawa E, Azeka E, Ignez ZM, et al. Factors associated with failure of weaning from longterm mechanical ventilation after cardiac surgery. Int Heart J 2005 46(5) 819-831. 

Scheinhorn D. Increase in serum albumin and decrease in body weight correlate with weaning from prolonged mechanical ventilation. Am Rev Respir Dis 1992 145 A522. 

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