When should a patient be weaned from mechanical ventilation?

Updated: Apr 11, 2019
  • Author: Christopher D Jackson, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

Weaning or, as some physicians prefer, "liberation from mechanical ventilation," is an important issue. Unnecessary delays in the withdrawal of mechanical ventilatory support increase the patient's risks for complications and increase the length of ICU stay and hospital costs. However, premature withdrawal from the ventilator can also be deleterious.

Weaning should be considered when the event that precipitated the patient's need for mechanical support is adequately addressed. Patients should be evaluated each day to determine if they are a candidate for weaning. Patients who may be able to support their own ventilation and oxygenation can often be recognized by assessing objective measurements or by asking the following questions:

  • Is the process responsible for the patient's respiratory failure resolving or improving?

  • Is the patient hemodynamically stable? Is the patient free of active cardiac ischemia or unstable arrhythmias, and vasopressor support absent or minimal?

  • Is oxygenation adequate with a PaO2 of greater than 60 mm Hg with an FiO2 of less than 40% and a PEEP of less than 5 cm water?

  • Are mental and neuromuscular statuses appropriate with the patient on minimal or no sedation? Does the patient have adequate strength of the respiratory muscles?

  • Are the acid-base status and electrolyte status optimized?

  • Is the patient afebrile?

  • Are the patient's adrenal and thyroid functions adequate to allow for weaning?


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