Inability to Wean from Ventilator

NOTE: This pathway is intended for use in patients in the intensive care unit who are unable to be extubated due to a suspected neurologic cause. 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.