Gradual versus abrupt weaning from respiratory support in acute respiratory failure and advanced chronic obstructive lung disease.

Abstract

Two methods of weaning from mechanical ventilation were compared in 18 instances of acute respiratory failure requiring mechanical ventilation for more than 30 days in patients with advanced chronic obstructive lung disease. All patients were ventilated using intermittent mandatory ventilation. Abrupt weaning (AW) consisted of abruptly discontinuing mechanical ventilation when the patients were considered ready for unassisted breathing. Gradual weaning (GW) involved a gradual reduction in the rate of intermittent mandatory ventilation before starting unassisted breathing. Gradual or abrupt weaning alone was used for weaning in five and four instances, respectively. Both methods were used in nine other instances. In the 14 instances when GW was tried, weaning was successful in three. In the 13 instances when AW was tried, weaning was successful in nine. The time in which mechanical ventilation was required was 64 +/- 31 (SD) days with GW and 42 +/- 12 (SD) days with AW. There was no difference in age, pulmonary function, or arterial blood gas results between the patients being weaned by the different methods. I conclude that GW offers no advantage over AW in weaning patients with advanced chronic obstructive lung disease requiring prolonged mechanical ventilation.