Editorial Views  |   September 2018
Weaning from Mechanical Ventilation: Have We, so Far, Missed a Crucial Point?
Author Notes
  • From the Department of Anesthesiology, Intensive Care and Emergency, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy (G.G.); Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy (G.G.); Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (G.B.); and Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy (G.B.).
  • Corresponding article on page 490.
    Corresponding article on page 490.×
  • Accepted for publication May 29, 2018.
    Accepted for publication May 29, 2018.×
  • Address correspondence to Dr. Bellani: giacomo.bellani1@unimib.it
Article Information
Editorial Views / Respiratory System
Editorial Views   |   September 2018
Weaning from Mechanical Ventilation: Have We, so Far, Missed a Crucial Point?
Anesthesiology 9 2018, Vol.129, 394-395. doi:10.1097/ALN.0000000000002337
Anesthesiology 9 2018, Vol.129, 394-395. doi:10.1097/ALN.0000000000002337
Functional impairment of respiratory muscles is considered one of the determinants of difficult weaning from the ventilator,1  which results in prolonged mechanical ventilation and is associated with worse patient outcome.2  Patients requiring invasive ventilation are exquisitely prone to the development of respiratory muscle dysfunction (including ventilator-induced diaphragmatic dysfunction), which is worsened by a number of concomitant factors like sepsis, electrolyte imbalance, malnutrition, and administration of aminoglicosides, steroids, and neuromuscular blockers. Most of the studies tackling this issue were focused on the dysfunction of inspiratory muscles, mostly the diaphragm. At variance, very few studies aimed at assessing the role of expiratory muscles.
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