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Weaning from mechanical ventilation

¹ Dept of Medical Intensive Care and Medical Emergencies, Hôpital de la Cavale Blanche University Hospital, Université de Bretagne Occidentale, Brest, ¹⁰ Medical Intensive Care Unit, Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris, Boulogne, France, ² Dept of Anaesthesia and Intensive Care Medicine, Queen Elizabeth Hospital, Birmingham, UK, ³ Case Dept of Medicine at MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, ⁷ Dept of Anaesthesia, Stanford University School of Medicine, Stanford, CA, ⁸ Dept of Medicine, University of Maryland Medical Center, Baltimore, MD, ⁹ Dept of Pulmonary and Critical Care Medicine, Rhode Island Hospital, Providence, RI, USA, ⁴ Dept of Medicine, Toronto General Hospital, Toronto, ON, Canada, ⁵ Dept of Anaesthesia and Intensive Care Medicine, Trinity College, Dublin, Ireland, ⁶ Dept of Intensive Care, Erasme Hospital, Free University of Brussels, Brussels, Belgium, ¹¹ Dept of Pulmonary Medicine, University of Hannover Medical School, Hannover, Germany.

CORRESPONDENCE: J-M. Boles, J-M. Boles, Service de Réanimation Médicale et Urgences Médicales, Hôpital de la Cavale Blanche, CHU, Bd Tanguy Prigent, 29609 Brest cedex, France. Fax: 33 298347965. E-mail: jean-michel.boles{at}chu-brest.frService de Réanimation Médicale et Urgences Médicales, Hôpital de la Cavale Blanche, CHU, Bd Tanguy Prigent, 29609 Brest cedex, France. Fax: 33 298347965. E-mail: jean-michel.boles{at}chu-brest.fr

Keywords: Mechanical ventilation, weaning from mechanical ventilation

Received: January 23, 2006
Accepted December 22, 2006

Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Many controversial questions remain concerning the best methods for conducting this process. An International Consensus Conference was held in April 2005 to provide recommendations regarding the management of this process. An 11-member international jury answered five pre-defined questions. 1) What is known about the epidemiology of weaning problems? 2) What is the pathophysiology of weaning failure? 3) What is the usual process of initial weaning from the ventilator? 4) Is there a role for different ventilator modes in more difficult weaning? 5) How should patients with prolonged weaning failure be managed?

The main recommendations were as follows. 1) Patients should be categorised into three groups based on the difficulty and duration of the weaning process. 2) Weaning should be considered as early as possible. 3) A spontaneous breathing trial is the major diagnostic test to determine whether patients can be successfully extubated. 4) The initial trial should last 30 min and consist of either T-tube breathing or low levels of pressure support. 5) Pressure support or assist–control ventilation modes should be favoured in patients failing an initial trial/trials. 6) Noninvasive ventilation techniques should be considered in selected patients to shorten the duration of intubation but should not be routinely used as a tool for extubation failure.

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