Liberation from Mechanical Ventilation
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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.