Features of Weaning after Prolonged Mechanical Ventilation in Patients with Secondary Ischemic Complications due to Intracranial Aneurysm Hemorrhages
Objective of the study: to explore the features of weaning and duration of respiratory support in patients with secondary ischemic complications due to intracranial aneurysm hemorrhages. Materials and methods. The study involved 60 patients with complicated intracranial aneurysm hemorrhages, who survived. For the treatment of secondary cerebral ischemia, therapeutic hypothermia was performed in 29 patients for 48 hours. Results. The duration of mechanical ventilation, weaning and total respiratory support, frequency of spontaneous breaths, as well as the relative duration of mechanical ventilation and weaning, didn’t depend on treatment options. At the beginning of weaning, patients were divided into three groups depending on the result of spontaneous breathing test. The first group consisted of 27 patients with normal mechanics of breathing. Duration of weaning in this group of patients was minimal — 1,357.0 ± 48.7 minutes. P0.1 index on the first day of weaning in this group of patients was 2.93 ± 0.20 mmH2O and was within the normal range all the time before patient’s transition to spontaneous breathing. The second group consisted of 15 patients with depression of respiratory drive. Average P0.1 in all patients amounted to 1.48 ± 0.37 and gradually increased over time. In patients with rapid shallow breathing (18 patients) during spontaneous breathing test, average output P0.1 was 3.75 ± 0.70, and from the second day of weaning it was statistically higher than the rates in the groups of normal mechanics of breathing and depression of respiratory drive (p = 0.001). Duration of weaning was 3,680.0 ± 126.4 minutes, which was significantly higher than in patients with normal mechanics of breathing (p = 0.00009), and lower than in patients with rapid shallow breathing (p = 0.00000001). Conclusions. The duration of respiratory support in patients with secondary ischemic complications due to intracranial aneurysm hemorrhages is independent of body temperature in the first 48 hours. Patients with secondary ischemic complications due to intracranial aneurysm hemorrhages at the beginning of weaning have three types of respiratory mechanics: normal one, impaired respiratory drive, rapid shallow breathing. Patients with depression of respiratory drive have the longest weaning.
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