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Editorial
November 13, 2018

Weaning From Mechanical VentilationWhat Should Be Done When a Patient’s Spontaneous Breathing Trial Fails?

Author Affiliations
  • 1Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
  • 2Institute of Health Policy Management and Evaluation, Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology, University of Toronto, Toronto, Ontario, Canada
  • 3Toronto General Research Institute, Division of Respirology, Department of Medicine, University Health Network, Mount Sinai Hospitals, Toronto, Ontario, Canada
JAMA. 2018;320(18):1865-1867. doi:10.1001/jama.2018.13762

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 A series of studies dating back 25 years has shown that most patients need to be liberated, rather than gradually withdrawn (weaned), from mechanical ventilation.1 The time point for liberation is identified by use of a spontaneous breathing trial, whereby after having shown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

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