Weaning from Mechanical Ventilation

  • I. Cortés
  • A. Esteban
Conference paper


Weaning describes the process of liberating the patient from mechanical ventilation. It is a withdrawal or discontinuation process that covers the transition from mechanical support to spontaneous breathing. In most patients, this transition is quick and uneventful once we realise that the respiratory failure has improved and the patient is ready for spontaneous breathing. However, a minority of mechanically ventilated patients (one of every four or five patients) will need a more gradual approach to weaning


Mechanical Ventilation Continuous Positive Airway Pressure Chronic Obstructive Pulmonary Disease Patient Spontaneous Breathing Pressure Support Ventilation 
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  1. 1.
    Esteban et al (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287: 345-355Google Scholar
  2. 2.
    Esteban et al (1994) Modes of mechanical ventilation and weaning: a national survey of Spanish hospitals; the Spanish Lung Failure Collaborative Group. Chest 106:1188-1193Google Scholar
  3. 3.
    Zilberberg MD, Luippold RS, Sulsky S et al (2008) Prolonged acute mechanical ventilation, hospital resource utilization, and mortality in the United States. Crit Care Med 36(3):724–730PubMedCrossRefGoogle Scholar
  4. 4.
    Boles JM, Bion J, Connors A et al (2007) Weaning from mechanical ventilation. Eur Respir J 29:1033–1056PubMedCrossRefGoogle Scholar
  5. 5.
    Funk GC, Anders S, Breyer MK et al (2010) Incidence and outcome of weaning from mechanical ventilation according to new categories. Eur Respir J 35:88–94PubMedCrossRefGoogle Scholar
  6. 6.
    Brochard L, Rauss A, Benito S et al (1994) Comparison of three methods of gradual withdrawal from ventilator support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150(4):896–903PubMedGoogle Scholar
  7. 7.
    Esteban A, Frutos F, Tobin MJ et al (1995) A comparison of four methods of weaning patients from mechanical ventilation. The Spanish Lung Failure Collaborative Group. N Engl J Med 332(6):345–50PubMedCrossRefGoogle Scholar
  8. 8.
    Ely EW, Baker AM, Evans GW et al (1999) The prognostic significance of passing a daily screen of weaning parameters. Intensive Care Med 25:581–587PubMedCrossRefGoogle Scholar
  9. 9.
    Saura P, Blanch L, Mestre J et al (1996) Clinical consequences of the implementation of a weaning protocol. Intensive Care Med 22:1052–1056PubMedCrossRefGoogle Scholar
  10. 10.
    Ely EW, Baker AM, Dunagan DP et al (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335:1864–1869PubMedCrossRefGoogle Scholar
  11. 11.
    Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation, N Engl J Med 324:1445–1450PubMedCrossRefGoogle Scholar
  12. 12.
    Tanios MA, Nevins ML, Hendra KP et al (2006) A randomized controlled trial of the role of weaning predictors in clinical decision making. Crit Care Med 34:1–10CrossRefGoogle Scholar
  13. 13.
    Nathan SD, Ishaaya AM, Koerner SK et al (1993) Prediction of minimal pressure support during weaning from mechanical ventilation. Chest 103:1215–1219PubMedCrossRefGoogle Scholar
  14. 14.
    Esteban A, Alía I, Gordo F et al (1997) Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 156:459–465PubMedGoogle Scholar
  15. 15.
    Ezingeard E, Diconne E, Guyomarc’h S et al (2006) Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing. Intensive Care Med 32(1):165–169PubMedCrossRefGoogle Scholar
  16. 16.
    Reissmann HK, Ranieri VM, Goldberg P et al. (2000) Continuous positive airway pressure facilitates spontaneous breathing in weaning chronic obstructive pulmonary disease patients by improving breathing pattern and gas exchange. Intensive Care Med 26(12):1764–1772PubMedCrossRefGoogle Scholar
  17. 17.
    Esteban A, Alía I, Tobin MJ et al. (1999) Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 159:512–551PubMedGoogle Scholar
  18. 18.
    Perren A, Domenighetti G, Mauri S et al. (2002) Protocol-directed weaning from mechanical ventilation: clinical outcome in patients randomized for a 30-min or 120-min trial with pressure support ventilation. Intensive Care Med 28:1058–1063PubMedCrossRefGoogle Scholar
  19. 19.
    Laghi F, D’Alfonso N, Tobin MJ (1995) Pattern of recovery from diaphragmatic fatigue over 24 hours. J Apply Physiol 79:539–546Google Scholar
  20. 20.
    Task Force by the American College of Chest Physicians; American Association for Respiratory Care and the American College of Critical Care Medicine (2001). Evidence-based guidelines for weaning and discontinuing ventilatory support. Chest 120:375S-395SGoogle Scholar
  21. 21.
    Butler R, Keenan SP, Inman KJ et al (1999) Is there a preferred technique for weaning the difficult-to-wean patient? A systematic review of the literature. Crit Care Med 27:2331–2336PubMedCrossRefGoogle Scholar
  22. 22.
    Tomlinson JF, Miller KS, Lorch DG et al (1989) A prospective comparison of IMV and T-piece weaning from mechanical ventilation. Chest 96:348–352PubMedCrossRefGoogle Scholar
  23. 23.
    Esen F, Denkel T, Telci L et al (1992) Comparison of pressure support ventilation (PSV) and intermittent mandatory ventilation (IMV) during weaning in patients with acute respiratory failure. Adv Exp Med Biol 317:371–376PubMedCrossRefGoogle Scholar
  24. 24.
    Epstein SK. (2002) Decision to extubate. Intensive Care Med 28:535–546PubMedCrossRefGoogle Scholar
  25. 25.
    Frutos-Vivar F, Ferguson ND, Esteban A et al (2006) Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 130:1664–1671PubMedCrossRefGoogle Scholar
  26. 26.
    Teixeira C, Zimmermann Teixeira PJ, Höher JA et al (2008) Serial measurements of f/VT can predict extubation failure in patients with f/VT < or = 105? J Crit Care 23:572–576PubMedCrossRefGoogle Scholar
  27. 27.
    Fernandez R, Raurich JM, Mut T et al (2004) Extubation failure: diagnostic value of occlusion pressure (P 0.1) and P 0.1-derived parameters. Intensive Care Med 30:234–240PubMedCrossRefGoogle Scholar
  28. 28.
    Vargas F, Boyer A, Bui HN et al (2008) Respiratory failure in chronic obstructive pulmonary disease after extubation: value of expiratory flow limitation and airway occlusion pressure after 0.1 second (P0.1). J Crit Care 23:577–584PubMedCrossRefGoogle Scholar
  29. 29.
    Epstein SK. (1995) Etiology of extubation failure and the predictive value of the rapid shallow breathing index. Am J Resp Crit Care Med 152:545–549PubMedGoogle Scholar
  30. 30.
    Salam A, Tilluckdharry L, Amoateng-Adjepong Y,et al (2004) Neurologic status, cough, secretions and extubation outcomes. Intensive Care Med 30:1334–1339PubMedCrossRefGoogle Scholar
  31. 31.
    Coplin WM, Pierson DJ, Cooley KD et al (2000) Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med 161:1530–1536PubMedGoogle Scholar
  32. 32.
    Namen AM, Ely EW, Tatter SB et al (2001) Predictors of successful extubation in neurosurgical patients. Am J respire Crit Care Med 163:658–664Google Scholar
  33. 33.
    Ochoa ME, Marin del M C, Frutos-Vivar F et al (2009) Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis. Intensive Care Med 35:1171–1179PubMedCrossRefGoogle Scholar
  34. 34.
    Epstein SK, Ciubotaru RL (1998) Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 158:489–493PubMedGoogle Scholar
  35. 35.
    Torres A, Aznar R, Gatell JM et al (1990) Incidence, risk, and prognosis factors of nosocomial pneumonia in patients needing mechanical ventilation. Am Rev Respir Dis 142:523–528PubMedCrossRefGoogle Scholar
  36. 36.
    Torres A, Gatell JM, Aznar E et al (1995) Re-intubation increases the risk of nosocomial pneumonia in mechanically ventilated patients. Am J Respir Crit Care Med 152:137–141PubMedGoogle Scholar
  37. 37.
    Nava S, Ambrosino N, Clini E et al (1998) Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized controlled trial. Ann Intern Med 128:721–728PubMedGoogle Scholar
  38. 38.
    Girault C, Daudenthun I, Chevron V et al (1999) Noninvasive ventilation as a systematic extubation and weaning technique in acute-on-chronic respiratory failure. A prospective, randomized controlled study. Am J Respir Crit Care Med 160:86–92PubMedGoogle Scholar
  39. 39.
    Ferrer M, Esquinas A, Arancibia F et al (2003) Noninvasive ventilation during persistent weaning failure. A randomized controlled trial. Am J Respir Crit Care 68:70–76CrossRefGoogle Scholar
  40. 40.
    Trevisan CE, Vieira SR. Research Group in Mechanical Ventilation Weaning (2008) Noninvasive mechanical ventilation may be useful in treating patients who fail weaning from invasive mechanical ventilation: a randomized controlled trial. Crit Care 12:136CrossRefGoogle Scholar
  41. 41.
    Burns KE, Adhikari NK, Meade MO (2003) Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev (4):CD004127PubMedGoogle Scholar
  42. 42.
    Burns KE, Adhikari NK, Keenan SP, Meade M (2009) Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: meta-analysis and systematic review. BMJ 338:b1574PubMedCrossRefGoogle Scholar
  43. 43.
    Keenan SP, Powers C, McCormack DG et al (2002) Noninvasive positive-pressure ventilation for postextubation respiratory distress: a randomized controlled trial. JAMA 287:3238–3244PubMedCrossRefGoogle Scholar
  44. 44.
    Esteban A, Frutos-Vivar F, Ferguson ND et al (2004) Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 350:2452–2460PubMedCrossRefGoogle Scholar
  45. 45.
    Jiang JS, Kao SJ, Wang SN (1999) Effect of early application of biphasic positive airway pressure on the outcome of extubation in ventilator weaning. Respirology 4:151–155CrossRefGoogle Scholar
  46. 46.
    Nava S, Gregoretti C, Fanfulla F et al (2005) Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med 33:2465–2470PubMedCrossRefGoogle Scholar
  47. 47.
    Ferrer M, Valencia M, Nicolas JM et al (2006) Early noninvasive ventilation averts extubation failure in patients at risk: a randomized controlled trial. Am J Respir Crit Care Med 173:164–170PubMedCrossRefGoogle Scholar
  48. 48.
    Ferrer M, Sellarés J, Valencia M et al (2009) Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. Lancet. 374:1082–1088PubMedCrossRefGoogle Scholar
  49. 49.
    Kollef MH, Levy MM, Ahrens TS et al (1998) The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest 114:541–548PubMedCrossRefGoogle Scholar
  50. 50.
    Kress JP, Pohlman AS, O’Connor MF et al (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477PubMedCrossRefGoogle Scholar
  51. 51.
    Kress JP, Gehibach B, Lacy M et al (2003) The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med 168:1457–1461PubMedCrossRefGoogle Scholar
  52. 52.
    Girard TD, Kress JP, Fuchs BD et al (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. Lancet 371:126–134PubMedCrossRefGoogle Scholar
  53. 53.
    Strøm T, Martinussen T, Toft P (2008) A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomized trial. Lancet 375:465–480Google Scholar
  54. 54.
    Brook AD, Ahrens TS, Schaiff R et al (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27:2609–2615PubMedCrossRefGoogle Scholar
  55. 55.
    De Jonghe B, Bastuji-Garin S, Fangio P et al (2005) Sedation algorithm in critically ill patients without acute brain injury. Crit Care Med 33:120–127PubMedCrossRefGoogle Scholar
  56. 56.
    Quenot JP, Ladoire S, Devoucoux F et al (2007) Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia. Crit Care Med 35:2031–2036PubMedCrossRefGoogle Scholar
  57. 57.
    Arias-Rivera S, Sánchez-Sánchez M, Santos-Díaz R et al (2008) Effect of a nursing-implemented sedation protocol on weaning outcome. Crit Care Med 36:2054–2060PubMedCrossRefGoogle Scholar
  58. 58.
    Garnacho-Montero J, Amaya-Villar R, García-Garmendía JL et al (2005) Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med 33:349–354PubMedCrossRefGoogle Scholar
  59. 59.
    De Jonghe B, Bastuji-Garin S, Sharshar T et al (2004) Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med 30:1117–1121PubMedCrossRefGoogle Scholar
  60. 60.
    Van den Berghe G, Schoonheydt K, Becx P et al (2005) Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology 64:1348–1353PubMedCrossRefGoogle Scholar
  61. 61.
    Hermans G, Wilmer A, Meersseman W et al (2007) Impact of intensive insulin therapy on neuromuscular complications and ventilator-dependency in MICU. Am J Respir Crit Care Med 175:480–489PubMedCrossRefGoogle Scholar
  62. 62.
    De Jonghe B, Bastuji-Garin S, Durand MC et al (2007) Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med 35:2007–2015PubMedCrossRefGoogle Scholar
  63. 63.
    Navalesi P, Frigerio P, Moretti MP et al (2008) Rate of reintubation in mechanically ventilated neurosurgical and neurologic patients: evaluation of a systematic approach to weaning and extubation. Crit Care Med 36:2986–2892PubMedCrossRefGoogle Scholar
  64. 64.
    Khamiees M, Raju P, DeGirolamo A et al (2001) Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 120:1262–1270PubMedCrossRefGoogle Scholar
  65. 65.
    Nava S, Rubini F, Zanotti E et al (1994) Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days. Eur Respir J 7:1645–1652PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • I. Cortés
  • A. Esteban

There are no affiliations available

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