S2k-Guideline “Prolonged Weaning”^[*]

Abstract

All mechanically ventilated patients must be weaned from the ventilator at some stage. According to an International Consensus Conference the criteria for “prolonged weaning” are fulfilled if patients fail at least 3 weaning attempts (i. e. spontaneous breathing trial, SBT) or require more than 7 days of weaning after the first SBT. This occurs in about 15 – 20 % of patients.

Because of the growing number of patients requiring prolonged weaning a German guideline on prolonged weaning has been developed. It is an initiative of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., DGP) in cooperation with other societies (see acknowledgement) engaged in the field chaired by the Association of Scientific and Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF).

This guideline deals with the definition, epidemiology, weaning categories, underlying pathophysiology, therapeutic strategies, the weaning unit, transition to out-of-hospital ventilation and therapeutic recommendations for end of life care.

This short version summarises recommendations on prolonged weaning from the German guideline.

Zusammenfassung

Die Entwöhnung von der maschinellen Beatmung (Weaning) umfasst einen wesentlichen Teil der gesamten Beatmungszeit. Dabei kommt es bei ca. 15 – 20 % der Patienten zu einem prolongierten Weaning, das nach internationaler Vereinbarung dann angenommen wird, wenn das Weaning erst nach drei erfolglosen Spontanatmungsversuchen (Spontaneous Breathing Trial = SBT) oder nach über 7 Tagen Beatmung nach dem ersten erfolglosen SBT gelingt. Auf Initiative der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP) gemeinsam mit anderen wissenschaftlichen Gesellschaften und unter der Moderation der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) e.V. wurde der aktuelle Wissensstand zum Thema „Prolongiertes Weaning“ in einer S2k-Leitlinie zusammengefasst. In dieser Leitlinie werden Definitionen, Epidemiologie und Weaningkategorien, die zugrunde liegende Pathophysiologie, die verfügbaren Therapiestrategien, die Weaningeinheit, die Überleitung in eine außerklinische Beatmung und schließlich Empfehlungen zu Therapieentscheidungen am Ende des Lebens bei prolon- giertem bzw. erfolglosem Weaning abgehandelt. Die Besonderheiten bei pädiatrischen Patienten werden innerhalb der einzelnen Kapitel jeweils gesondert behandelt. In der vorliegenden Kurzfassung werden die wesentlichen Aspekte und Empfehlungen dieser Leitlinie zum prolongierten Weaning vorgestellt.

^* Authors’ contributions: The authors listed in this publication represent the leaders of the different subject areas during the guideline development. They all participated in the consensus conferences of this project and had responsibility for the preparation of the original document. BS, OM, JG and DD structured, prepared and translated the English written document for this publication.

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