Weaning from Mechanical Ventilation in ARDS: Aspects to Think about for Better Understanding, Evaluation, and Management

Table 1

Potential methods for predicting weaning in ARDS.

Potential Method	Advantages	Disadvantages
Esophageal pressure[42, 43]	Pressure measurements with spontaneous ventilation; Quantification of pulmonary swings; Help in the visualization of asynchrony	Difficulty in positioning the catheter and its accuracy for measuring esophageal pressure; Minimally Invasive
P0.1[44, 45]	Evaluation of ventilatory drive	Failure of previous studies as a predictor of general weaning failure
Lung ultrasound; [46–48]	Non-invasive; Quantification of aeration and collapse during weaning	Operator dependent; Skin lesions may make it impossible to perform the test
Echocardiography[49]	Evaluation of the heart-lung interaction; Measures left and right ventricular function	Same as above; Cardiac images are difficult to visualize in some patients
Asynchrony[36, 50]	Quantification of asynchrony and better adjustment of parameters and modes of mechanical ventilation during weaning	Automatic devices that are validated for clinical use are missing
EIT[51–54]	Non-invasive and radiation-free; Real-time visualization of aeration and collapsed lung and swings during weaning; Evaluation of pulmonary perfusion	Artifacts caused by changes in thoracic shape, providing three-dimensional; absolute/relative images with better resolution
Biomarkers[55]	Evaluation of VILI and P-SILI worsening during mechanical ventilation weaning	Influence by extrapulmonary inflammatory response

EIT: Electrical Impedance Tomography; VILI: Ventilator-Induced Lung Injury; P-SILI: patient self-inflicted lung injury.