Let air out of the bowel to allow more air in the lungs: surgical treatment of weaning failure

After a protracted period of failed weaning from mechanical ventilation, he was transferred to a regional weaning centre 7 months after the initial operation. Since the surgery, the patient had complained of abdominal bloating and discomfort with distended bowel loops observed on the plain abdominal film. Because of frailty of the patient, a conservative management approach was taken, including high positive extrinsic pressure to enhance lung volume and the use of prokinetics, low-volume enteral feeding, regular aspiration of air from the nasogastric tube, sitting out and mobilisation, a bowel management regime, pancreatic enzyme replacement and high-dose cholinesterase inhibitor to promote peristalsis and reduce bowel distension. 2 This case illustrates the potential novel use of PEC in patients with severe colonic distension who are refractory to conservative measures, leading to diaphragmatic splinting, and impaired weaning from mechanical ventilation.