Methods of weaning from mechanical ventilation
- Scott K Epstein, MD
Scott K Epstein, MD
- Professor of Medicine
- Tufts University School of Medicine
- Allan Walkey, MD, MSc
Allan Walkey, MD, MSc
- Assistant Professor of Medicine
- The Pulmonary Center, Boston University School of Medicine
Discontinuation of mechanical ventilation is a two-step process, consisting of readiness testing and weaning:
●Readiness testing – Readiness testing is the evaluation of objective criteria to determine whether a patient might be able to successfully and safely wean from mechanical ventilation.
●Weaning – Weaning is the process of decreasing the amount of support that the patient receives from the mechanical ventilator, so the patient assumes a greater proportion of the ventilatory effort. The purpose is to assess the probability that mechanical ventilation can be successfully discontinued. Weaning may involve either an immediate shift from full ventilatory support to a period of breathing without assistance from the ventilator or a gradual reduction in the amount of ventilator support [1,2]. Weaning has also been referred to as the discontinuation of mechanical ventilation or liberation from the mechanical ventilator.
Patients who wean successfully have less morbidity, mortality, and resource utilization than patients who require prolonged mechanical ventilation or the reinstitution of mechanical ventilation [3-6]. The most successful weaning strategies include a daily assessment of the patient's readiness to wean and the careful use of sedatives [7,8].
Weaning methods are reviewed here. Assessment of a patient's readiness to wean and the extubation process are described separately. (See "Weaning from mechanical ventilation: Readiness testing" and "Extubation management".)
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