Liberation from mechanical ventilation in heart failure

Heart failure poses special challenges in liberation from mechanical ventilation, whether the heart failure is the principal reason for mechanical ventilation or is a complication of other disease states leading to mechanical ventilation. Mechanical ventilation decreases preload and afterload, effects which are beneficial to cardiac function. When the ventilator is removed these effects are lost and otherwise stable patients may decompensate quickly. This review covers pathophysiology and strategies for successful removal of invasive ventilation.