Abstract
Practice guidelines on weaning should be based on the results of several well-designed randomized studies performed over the last decade. One of those studies demonstrated that immediate extubation after successful trials of spontaneous breathing expedites weaning and reduces the duration of mechanical ventilation as compared with a more gradual discontinuation of ventilatory support. Two other studies showed that the ability to breathe spontaneously can be adequately tested by performing a trial with either T-tube or pressure support of 7 cmH2O lasting either 30 or 120 min. In patients with unsuccessful weaning trials, a gradual withdrawal for mechanical ventilation can be attempted while factors responsible for the ventilatory dependence are corrected. Two randomized studies found that, in difficult-to-wean patients, synchronized intermittent mandatory ventilation (SIMV) is the most effective method of weaning.
Highlights
Weaning from mechanical ventilation can be defined as the process of abruptly or gradually withdrawing ventilatory support
The daily screening of patients who are on mechanical ventilation with the aim of identifying those able to breathe spontaneously is, possibly, the best approach to reduce the duration of ventilatory support
Standard weaning criteria were used in all of the aforementioned studies to identify patients who were able to resume spontaneous breathing, and patients who did not meet such criteria remained on mechanical ventilation
Summary
Weaning from mechanical ventilation can be defined as the process of abruptly or gradually withdrawing ventilatory support. The first study that dealt with this issue [16] compared continuous positive airway pressure of 5 cmH2O and T-piece in a group of 106 mechanically ventilated patients who underwent a 1-h trial of spontaneous breathing, and no difference in the percentage of patients failing extubation was found. In the study by Nava et al [33], 50 COPD patients who failed a T-tube trial after 36–48 h of mechanical ventilation were randomized to either immediate extubation with noninvasive pressure support via a face mask and a standard ventilator, or continued pressure support via an endotracheal tube Both groups underwent trials of spontaneous breathing at least twice each day and reductions in the pressure support level of 2–4 cmH2O/day as tolerated in an attempt to discontinue mechanical ventilation entirely. There was no significant difference in the percentage of patients who required reintubation (15% in the unassisted oxygen therapy group and 28% in the biphasic positive airway pressure group)
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