First Things First

• The term "weaning" from mechanical ventilation (MV) implies a gradual process, which is generally not required. "Liberation" or "discontinuation" from MV is more accurate. Optimal methods include:
  • Avoiding unnecessarily slow methods, which increase ventilator days and lead to increased complications associated with MV (e.g., nosocomial pneumonia)
  • Avoiding overaggressive discontinuation efforts, which result in increased rates of reintubation. The optimal reintubation rate is unknown but most estimate it to be 5-10%.
• The weaning phase does not involve the training of respiratory muscles to permit return of spontaneous breathing in ≥95% of subjects. It is a method to identify when the condition that required mechanical ventilation has improved sufficiently to allow resumption of spontaneous ventilation.
• Institutions with protocols to weaning (vs. unlimited physician variability) have lower # days on MV.