Weaning from mechanical ventilation

A significant number of critically ill patients require prolonged invasive mechanical ventilation and are difficult to wean from support. A protocolised approach to weaning, with daily screening for the ability to breath spontaneously and cessation of sedation, improves outcome. Some modes of ventilation (pressure support) are better than others (synchronised intermittent mandatory ventilation) at promoting weaning. Elective non-invasive ventilation after extubation may prevent re-intubation in certain patients, particularly those with chronic obstructive pulmonary disease. A small number of patients will need long-term ventilatory support; these are best assessed and managed by specialist units.