Inability to wean from ventilator in ICU setting

Neuromuscular cause for respiratory weakness should be considered in a patient whose mental status does not preclude extubation and other contributing conditions (pulmonary, cardiac, etc.) have been excluded. Diaphragmatic weakness resulting in the inability to wean a patient from mechanical ventilation may be due to a previously undiagnosed or subclinical neuromuscular condition or due to hospitalization or iatrogenic causes, with ICU acquired diaphragmatic weakness remaining a common etiology in the in-patient setting. History taking should include inquiring about symptoms of neuromuscular weakness prior to hospitalization to suggest a primary neurologic cause. History from the patient is often limited given the patient’s intubated state and therefore obtaining collateral history from individuals in close contact with the patient Neuromuscular cause for respiratory weakness should be considered in a patient whose mental status does not preclude extubation and other contributing conditions (pulmonary, cardiac, etc.) have been excluded. Diaphragmatic weakness resulting in the inability to wean a patient from mechanical ventilation may be due to a previously undiagnosed or subclinical neuromuscular condition or due to hospitalization or iatrogenic causes, with ICU acquired diaphragmatic weakness remaining a common etiology in the in-patient setting. History taking should include inquiring about symptoms of neuromuscular weakness prior to hospitalization to suggest a primary neurologic cause. History from the patient is often limited given the patient’s intubated state and therefore obtaining collateral history from individuals in close contact with the patient is crucial.