Liberation from Mechanical Ventilation

Abstract Summary Prolonged mechanical ventilation accounts for an important number of intensive care unit bed days. Weaning is the process of moving towards liberation from mechanical ventilation following resolution of the acute physiological insult that resulted in intensive care admission. Weaning is not simply the reduction of ventilator pressure support but is the global process of progressing a ventilator-dependent patient to return to spontaneous breathing and subsequent extubation or decannulation from tracheostomy. While readiness testing and simple weaning can be protocol driven, patients who progress from difficult weaning to prolonged mechanical ventilation will often require detailed physiological assessment in order to identify the reason for weaning failure. Complex weaning involves not just attention to the respiratory physiological impairment but a multi-disciplinary approach involving physical rehabilitation and psychological support to tackle the invariably present co-morbidities that will halt weaning. This appears to be most cost-effectively delivered in specialist centres.