Prolonged Weaning: S2k Guideline Published by the German Respiratory Society
Respiration
Schönhofer, B., Geiseler, J., et al. (2021).
Respiration, 99(11), 982-1084.
This guideline provides consensus-based recommendations on the management of patients undergoing prolonged weaning of mechanical ventilation.
German Respiratory Society
<div>Before decannulation, it is recommended that aspiration is specifically ruled out using clinical and, if possible, technically-assisted (e.g., fiberoptic endoscopic evaluation of swallowing) examinations.</div>
<div>It is recommended that regular swallowing treatment occur under the guidance of a speech-language pathologist if dysphagia is present following invasive mechanical ventilation. "Therapy should always be carried out on an interdisciplinary basis; amongst other things, logopaedic measures after long-term intubation or tracheostomy are available in prolonged weaning" (p. 1040).</div>
<div>Given that the risk for aspiration has been ruled out, it is recommended that the tracheal cannula is deflated during spontaneous breathing phases to reduce the work of breathing and improve speaking function. Speech-language pathology has a central role in the assessment and intervention of speaking and swallowing function in tracheal cannula and secretion management; therefore, an expert in speech-language pathology should be consulted into this treatment process until the point of decannulation.</div>
<div>Following invasive mechanical ventilation, it is recommended that an early test for the presence of dysphagia is conducted before beginning oral food intake. "Particularly for neurological patients in prolonged weaning, it is important that the possibility of dysphagia is always considered and that is it ruled out or confirmed, not only by clinical examination, but also with the aid of [fiberoptic endoscopic evaluation of swallowing] FEES" (pp. 1038-1039).</div>
