Weaning from Mechanical Ventilation

Abstract

An aggressive and protocolized approach to ventilator weaning will lead to decreased duration of mechanical ventilation and subsequent decreased morbidity and mortality. Maintenance of homeostasis of systems outside the respiratory system is essential to successful ventilator weaning. In addition to allowing for assessment of weaning readiness, a spontaneous breathing trial (SBT) may prevent the atrophy of the diaphragm and chest wall muscles. Weaning protocols are instituted in many ICUs to ensure that all intubated patients are evaluated on a daily basis for readiness to wean. Weaning protocols are often used in combination with sedation protocols. The goal is daily interruption of sedatives or maintaining patients in an alert, comfortable state so that weaning can progress and extubation performed at the earliest moment. Non-invasive positive pressure ventilation can be used immediately after extubation in selected patients who show borderline parameters during their SBT but are deemed likely to tolerate extubation with pressure support.