Protocol-guided weaning: A key-issue in reducing the duration of mechanical ventilation

Abstract

The process of weaning, if poorly organized, adds additional time to the duration of mechanical ventilation. Recent prospective studies have shown that the implementation of a protocol-directed weaning leads to an earlier initiation of the weaning process and a significant reduction in the duration of mechanical ventilation. Both daily screening of the respiratory function and trials of spontaneous breathing are valuable tools that should be incorporated into a weaning protocol. Extubation of the ventilated patients as soon as their recovery and ability to spontaneously breath are documented should be encouraged, because there is sufficient evidence that 65-70% of ventilated patients can be successfully extubated after a trial of spontaneous breathing is attempted. A gradual withdrawal of mechanical ventilation can be attempted in patients failing spontaneous breathing trials. Two randomized studies have found that the strategy used to discontinue mechanical ventilation influences the rate and degree of weaning success and that SIMV is the least efficient technique of weaning.