Weaning / Discontinuation of  Mechanical Ventilation

Weaning (discontinuation) from mechanical ventilation.

This subject actually involves two actions – withdrawal of mechanical ventilation and removal of the endotracheal tube (artificial airway). The method used to achieve permanent discontinuation of respiratory support depends upon the reason why the patient was intubated in the first place, for how long they remained on artificial ventilation and how much sedation was given.  In general it appears that it does not matter what method is used to wean patients as long as the ICU staff are familiar with the method.

It is not in patients’ interests to remain on mechanical ventilation they are at significant risk for:

• Nosocomial Pneumonia
• Stretch injury and barotrauma
• Airway trauma
• Prolonged Sedation

Along with the obvious increase in costs associated with prolonged ventilation.

Nevertheless, premature extubation is associated with:

• Loss of airway protection (aspiration).
• Hypoxemia
• Sympathetic discharge – cardiovascular stress.
• Muscular fatigue and acidosis
• Reintubation into an edematous airway (risk of hypoxic brain injury etc).

Weaning from ventilation is a multisystem approach – the lungs are only bit part players. We will look at weaning and extubation in the opposite way to which we addressed commencement of mechanical ventilation.

Indications for weaning and extubation:

• The patient is able to ventilate
• The patient is able to oxygenate
• The patient is able to protect his/her airway

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