No ventilatory complications of ARDS: Difficult weaning and intensive care unit-acquired weakness

Abstract

Acute respiratory distress syndrome (ARDS) is one of the most frequently studied entities of lung injury due to its prevalence in the Units of critically ill patients, because of their varied etiology and its evolution, since it depends on the type and length of treatment used, and the individual characteristics of each patient. While the symptoms and signs described in its redefinition by the Berlin consensus have been standardized, the clinical manifestations are different in patients that develop ARDS. Acute management determines the patient's prognosis in both the short and long term relative to technologies applied by a multidisciplinary team to patient management, and thus prevents the associated complications. The complications of ARDS have changed over time and currently require more individual clinical handling. Complications include not only respiratory types (which are still the most frequent), but also musculoskeletal types, the associated delirium and failure to wean, among others. This is because the treatments have evolved into more sophisticated technologies, increasing the associated protocols, ventilatory management, prone position and extracorporeal membrane oxygenation (ECMO), which entails various complications. The difficult weaning is one of the major complications associated with long development of a ventilated patient with ARDS. While it is not a ventilatory complication as such, it fails because patients may have ventilator-induced lung injury (VILI). Other conditions not associated with difficult weaning include the severity of the condition, the use of neuromuscular relaxant drugs and the evolution time of ARDS, which leads to failure at weaning. This is associated with respiratory muscle failure and often with the change of the endotracheal tube to a tracheostomy. This facilitates training and subsequent rehabilitation. Moreover, added to this condition is Intensive Care Unit-Acquired Weakness (ICUAW). This alteration is due to the immobility caused by sedation, neuromuscular relaxation and other drugs, and determines a significant amount of musculoskeletal deconditioning, which in clinical terms is forgotten in the first instance for the management of respiratory failure. However, in the recovery period it acquires importance in a patient's rehabilitation and functional recovery.