Withdrawal from Mechanical Ventilation in Patients with COPD: The Issue of Congestive Heart Failure

  • B. Cabello
  • J. Mancebo
Conference paper


Weaning or liberation from mechanical ventilation in patients with respiratory failure begins when the precipitating cause is partially or totally reversed. The aim of this process is to induce spontaneous breathing and, ultimately, extubation.


Chronic Obstructive Pulmonary Disease Mechanical Ventilation Respir Crit Spontaneous Breathing Trial Dynamic Hyperinflation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Ely EW, Baker AM, Evans GW, Haponik EF (1999) The prognostic significance of passing a daily screen of weaning parameters. Intensive Care Med 25: 581–587PubMedCrossRefGoogle Scholar
  2. 2.
    Mancebo J (1996) Weaning from mechanical ventilation. Eur Respir J 9: 1923–1931PubMedCrossRefGoogle Scholar
  3. 3.
    Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342: 14711477Google Scholar
  4. 4.
    Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Mancebo J (1998) 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 158: 1855–1862PubMedCrossRefGoogle Scholar
  5. 5.
    Ely EW, Baker AM, Dunagan DP, et al (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335: 18641869Google Scholar
  6. 6.
    Jubran A (2002) Weaning induced cardiac failure. In: Mancebo J, Net A, Brochard L (eds) Mechanical Ventilation and Weaning. Springer, Heidelberg, pp 184–192Google Scholar
  7. 7.
    Derenne P, Fleury B, Pariente R (1988) Acute respiratory failure of chronic obstructive pulmonary disease. Am Rev Respir Dis 138: 1006–1033PubMedCrossRefGoogle Scholar
  8. 8.
    Tuxen DV (1994) Permissive hypercapnic ventilation. Am J Respir Crit Care Med 150: 870874Google Scholar
  9. 9.
    Decramer M (1997) Hyperinflation and respiratory muscle interaction. Eur Respir J 10: 934–941PubMedGoogle Scholar
  10. 10.
    Lessard MR, Lofaso F, Brochard L (1995) Expiratory muscle activity increases intrinsic positive end-expiratory pressure independently of dynamic hyperinflation in mechanically ventilated patients. Am J Respir Crit Care Med 151: 562–569PubMedCrossRefGoogle Scholar
  11. 11.
    Rossi A, Polese G, Brandi G, Conti G (1995) Intrinsic positive end-expiratory pressure ( PEEPi ). Intensive Care Med 21: 522–536Google Scholar
  12. 12.
    Petrof BJ, Legare M, Goldberg P, Milic-Emili J, Gottfried SB (1990) Continuos positive airway pressure reduced work of breathing and dyspnea during from mechanical ventilation in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 141: 281–289PubMedCrossRefGoogle Scholar
  13. 13.
    Jubran A, Tobin MJ (1997) Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med 155: 906–915PubMedCrossRefGoogle Scholar
  14. 14.
    De Troyer A (1997) Effect of hyperinflation on the diaphragm. Eur Respir J 10: 708–713PubMedGoogle Scholar
  15. 15.
    Ranieri VM, Giuliani R, Cinnella G, et al (1993) Physiologic effects of positive end-expiratory pressure in patients with chronic obstructive pulmonary disease during acute ventilatory failure and controlled mechanical ventilation. Am Rev Respir Dis 147: 5–13PubMedCrossRefGoogle Scholar
  16. 16.
    Broseghini C, Brandolese R, Poggi R, et al (1988) Respiratory mechanics during the first day of mechanical ventilation in patients with pulmonary edema and chronic airway obstruction. Am Rev Respir Dis 138: 355–361PubMedCrossRefGoogle Scholar
  17. 17.
    Smith TC, Marini JJ (1988) Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction. J Appl Physiol 65: 1488–1499PubMedGoogle Scholar
  18. 18.
    Mancebo J, Albaladejo P, Touchard D, et al (2000) Airway occlusion pressure to titrate positive end-expiratory pressure in patients with dynamic hyperinflation. Anesthesiology 93: 81–90PubMedCrossRefGoogle Scholar
  19. 19.
    Ranieri VM, Dambrosio M, Brienza N (1996) Intrinsic PEEP and cardiopulmonary interaction in patients with COPD and acute ventilatory failure. Eur Respir J 9: 1283–1292PubMedCrossRefGoogle Scholar
  20. 20.
    Pinsky MR (2000) Breathing as exercise: the cardiovascular response to weaning from mechanical ventilation. Intensive Care Med 26: 1164–1166PubMedCrossRefGoogle Scholar
  21. 21.
    Miró M, Pinsky MR (1994) Heart-lung interactions. In: Tobin MJ (ed) Principles and Practice of Mechanical Ventilation. McGraw-Hill, New York, pp 647–671Google Scholar
  22. 22.
    Jones NL, Killian KJ (2000) Exercise limitation in health and disease. N Engl J Med 343: 632–641PubMedCrossRefGoogle Scholar
  23. 23.
    O’Donnell DE, Revill SM, Webb KA (2001) Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 164: 770–777PubMedCrossRefGoogle Scholar
  24. 24.
    Lemaire F, Teboul JL, Cinotti L, et al (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 69: 171–179PubMedCrossRefGoogle Scholar
  25. 25.
    Gandhi SK, Powers JC, Nomeir AM, et al (2001) The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med 344: 17–22PubMedCrossRefGoogle Scholar
  26. 26.
    Poppas A, Rounds S (2002) Congestive heart failure. Am J Respir Crit Care Med 165: 4–8PubMedCrossRefGoogle Scholar
  27. 27.
    Jubran A, Mathru M, Dries D, et al (1998) Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med 158: 1763–1769PubMedCrossRefGoogle Scholar
  28. 28.
    Scharf SM, Iqbal M, Keller C, et al (2002) Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med 166: 314–322PubMedCrossRefGoogle Scholar
  29. 29.
    Richard C, Teboul JL, Archambaud F, et al (1994) Left ventricular function during weaning of patients with chronic obstructive pulmonary disease. Intensive Care Med 20: 181–186PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • B. Cabello
  • J. Mancebo

There are no affiliations available

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