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Review
. 2022 Nov;37(11):1417-1425.
doi: 10.1177/08850666221095436. Epub 2022 Jul 11.

To Wean or Not to Wean: A Practical Patient Focused Guide to Ventilator Weaning

Padmastuti Akella  1 , Louis P Voigt  1 , Sanjay Chawla  1
Affiliations
Review

To Wean or Not to Wean: A Practical Patient Focused Guide to Ventilator Weaning

Padmastuti Akella et al. J Intensive Care Med. 2022 Nov.

Abstract

Since the inception of critical care medicine and artificial ventilation, literature and research on weaning has transformed daily patient care in intensive care units (ICU). As our knowledge of mechanical ventilation (MV) improved, so did the need to study patient-ventilator interactions and weaning predictors. Randomized trials have evaluated the use of protocol-based weaning (vs. usual care) to study the duration of MV in ICUs, different techniques to conduct spontaneous breathing trials (SBT), and strategies to eventually extubate a patient whose initial SBT failed. Despite considerable milestones in the management of multiple diseases contributing to reversible respiratory failure, in the application of early rehabilitative interventions to preserve muscle integrity, and in ventilator technology that mitigates against ventilator injury and dyssynchrony, major barriers to successful liberation from MV persist. This review provides a broad encompassing view of weaning classification, causes of weaning failure, and evidence behind weaning predictors and weaning modes.

Keywords: mechanical ventilation; spontaneous breathing trial; ventilator discontinuation; weaning.

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Conflict of interest statement

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Ineffective triggering on a ventilator: airway pressure and flow waveforms.
Figure 2.
Figure 2.
Hemodynamic and cardiopulmonary interactions during SBT.
See this image and copyright information in PMC

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