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Remembrance of weaning past: the seminal papers

Abstract

The approach to ventilator weaning has changed considerably over the past 30 years. Change has resulted from research in three areas: pathophysiology, weaning-predictor testing, and weaning techniques. Physiology research illuminated the mechanisms of weaning failure. It also uncovered markers of weaning success. Through more reliable prediction, patients whose weaning would have been tedious in the 1970s are now weaned more rapidly. The weaning story offers several lessons in metascience: importance of creativity, the asking of heretical questions, serendipity, mental-set psychology, cross-fertilization, and the hazards of precocity. Weaning research also illustrates how Kuhnian normal (me-too) science dominates any field. Making the next quantum leap in weaning will depend on spending less time on normal science and more on the raising (and testing) of maverick ideas.

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Acknowledgements

Supported by a Merit Review grant from the Veterans Administration Research Service and by the National Institute of Health (RO1 NR008782).

Author information

Correspondence to Martin J. Tobin.

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Tobin, M.J. Remembrance of weaning past: the seminal papers. Intensive Care Med 32, 1485–1493 (2006). https://doi.org/10.1007/s00134-006-0338-8

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Keywords

  • Mechanical ventilation
  • Weaning
  • Pathophysiology
  • Control of breathing
  • Respiratory muscles
  • Diagnostic testing
  • Monitoring
  • Randomized clinical trials
  • Metascience
  • Serendipity
  • Cross-fertilization