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The COVID-19 pandemic caused by SARS-CoV-2 has posed significant challenges in the management of critically ill patients, particularly those requiring mechanical ventilation (MV) due to severe respiratory failure. This review explores the pathophysiology of severe COVID-19, characterized by acute respiratory distress syndrome (ARDS), hyperinflammation, and vascular complications that complicate MV and the weaning process. Factors influencing weaning include patient-specific conditions such as ICU-acquired weakness, disease-related factors such as persistent inflammation, and ventilator-related challenges such as ventilator-induced lung injury. Key strategies for weaning include spontaneous breathing trials (SBTs), gradual reduction of ventilatory support, and use of advanced ventilator modes such as proportional assist ventilation (PAV). Adjunctive therapies, including inspiratory muscle training and early mobilization, are emphasized to improve respiratory muscle strength and functional outcomes. Extubation protocols, infection control measures, and post-extubation care are critical to minimizing complications such as reintubation and ventilator-associated pneumonia (VAP). Emerging technologies, including telemonitoring and AI-based decision support, offer promising advances in personalized weaning strategies. A multidisciplinary approach integrating rehabilitation and tailored protocols is essential to optimize outcomes. Lessons learned from COVID-19 provide valuable insights for future management of viral-induced ARDS and similar critical care scenarios.

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Weaning from Mechanical Ventilation in Patients with COVID-19

  • 章节

  • 发表日期：

    2025年

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  • Luis Felipe da Fonseca Reis,
  • Flávio Maciel de Andrade

摘要

The COVID-19 pandemic caused by SARS-CoV-2 has posed significant challenges in the management of critically ill patients, particularly those requiring mechanical ventilation (MV) due to severe respiratory failure. This review explores the pathophysiology of severe COVID-19, characterized by acute respiratory distress syndrome (ARDS), hyperinflammation, and vascular complications that complicate MV and the weaning process. Factors influencing weaning include patient-specific conditions such as ICU-acquired weakness, disease-related factors such as persistent inflammation, and ventilator-related challenges such as ventilator-induced lung injury. Key strategies for weaning include spontaneous breathing trials (SBTs), gradual reduction of ventilatory support, and use of advanced ventilator modes such as proportional assist ventilation (PAV). Adjunctive therapies, including inspiratory muscle training and early mobilization, are emphasized to improve respiratory muscle strength and functional outcomes. Extubation protocols, infection control measures, and post-extubation care are critical to minimizing complications such as reintubation and ventilator-associated pneumonia (VAP). Emerging technologies, including telemonitoring and AI-based decision support, offer promising advances in personalized weaning strategies. A multidisciplinary approach integrating rehabilitation and tailored protocols is essential to optimize outcomes. Lessons learned from COVID-19 provide valuable insights for future management of viral-induced ARDS and similar critical care scenarios.