Basic Invasive Mechanical Ventilation

Benjamin D. Singer, MD; Thomas C. Corbridge, MD


South Med J. 2009;102(12):1238-1245. 

In This Article

Weaning from the Ventilator

In light of these serious complications, it is important to frequently assess the need for continued intubation and mechanical ventilation.[24] Weaning or liberating patients from the ventilator begins by identifying patients who can breathe spontaneously. Patients with reversed sedation, stable vital signs, minimal secretions, and adequate gas exchange are candidates for a spontaneous breathing trial (SBT).[25] An SBT may be conducted by having the patient breathe via a T-piece, in which the ventilator is disconnected and the patient breathes through the endotracheal tube connected to a humidified oxygen supply. An alternative SBT is to use low level PSV (ie 5 cm H2O with 5 cm H2O of PEEP) to overcome the resistance of the endotracheal tube. An SBT is considered a failure if the patient has deteriorating arterial blood gas levels, excessive tachypnea or work of breathing, arrhythmias, hypertension or hypotension, diaphoresis, or anxiety. A patient who is comfortable after 30–120 minutes of an SBT may be evaluated for extubation.


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