Ventilator Weaning

Excerpt

Mechanical ventilation is an established supportive treatment for patients with various forms of respiratory failure. Despite the widespread use and clear benefits of mechanical ventilation, it is not a risk-free intervention. Prolonged mechanical ventilation increases the risk of pneumonia, barotrauma, tracheal injuries, and musculoskeletal deconditioning. At the same time, delayed weaning is associated with increased morbidity, mortality, hospital stay, and risk of long-term care facility discharge.

For most patients (70%), weaning from mechanical ventilation is a straightforward process. That usually entails extubation after the passage of the first spontaneous breathing trial (SBT). The remaining 30% of patients represent a challenge for ICU physicians. Difficulties usually arise in patients with chronic obstructive and restrictive pulmonary disease, heart failure, and neuromuscular disorders, among other potential causes.

The weaning process comprises almost 42% of the total duration of the ventilation. In our discussion, we review the most common barriers to successful ventilator weaning and the various extubation readiness assessment tools.