Withdrawing invasive mechanical ventilation from patients who require ventilatory support is one of the best studied areas in intensive care medicine. A series of studies dating back 25 years has shown that most patients need to be liberated, rather than gradually withdrawn (weaned), from mechanical ventilation.1 The time point for liberation is identified by use of a spontaneous breathing trial, whereby after having shown clinical improvement in the initial reason for ventilation and satisfying several safety criteria, patients are provided with minimal or no ventilatory assistance and their ability to tolerate and maintain spontaneous breathing is assessed. Using this approach, 55% to 75% of patients have successful extubation within 24 hours of their first successful spontaneous breathing trial and are deemed “easy to wean,” patients who require up to 1 additional week of ventilatory support are “difficult to wean,” and those needing more than 1 additional week require “prolonged weaning.”2,3
Munshi L, Ferguson ND. Weaning From Mechanical Ventilation: What Should Be Done When a Patient’s Spontaneous Breathing Trial Fails? JAMA. 2018;320(18):1865–1867. doi:10.1001/jama.2018.13762
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