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June 11, 2019

Revisiting, Reframing, and Casting a New Light on Liberation From Mechanical Ventilation

Author Affiliations
  • 1Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
  • 3Division of Critical Care Medicine, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
  • 4Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
JAMA. 2019;321(22):2167-2169. doi:10.1001/jama.2019.7364

Every year, more than 1 million patients throughout the world receive mechanical ventilation for acute respiratory failure. One of the most important decisions clinicians make in managing these critically ill patients is how to liberate them from invasive ventilation. Ventilator liberation poses an important dilemma for clinicians because premature or failed attempts at extubation, which typically necessitate reintubation, increase rates of ventilator-associated pneumonia, mortality, and other adverse outcomes.1 Conversely, delaying extubation also increases a patient’s risk of being oversedated and developing delirium or ventilator-associated events.2