Weaning from mechanical ventilation

Also known as Ventilator weaning · Spontaneous breathing trial (SBT) · Extubation criteria · Rapid shallow breathing index (RSBI) · Daily sedation interruption

Weaning from mechanical ventilation is the process of transitioning from full ventilatory support to spontaneous breathing and extubation. The key principle: daily assessment of readiness + spontaneous breathing trial (SBT). Daily SAT (sedation awakening trial) + SBT pairing reduces ventilation days and mortality. SBT methods: T-piece, pressure support (5-8 cmH2O), or CPAP (5 cmH2O) for 30-120 minutes. Extubation success predictors: RSBI (f/VT) <105, strong cough, good secretion clearance, cuff leak present (if prolonged intubation). Failure indicators: RR 35, SpO2 <90%, HR 140, agitation, diaphoresis. Failed SBT → return to ventilator, investigate cause, retry in 24h.

high26 referencesUpdated 19 Aug 202615 min readVerification in progress

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8 MCQs

Meet the patient

Day 5 of ventilation for a COPD exacerbation: the patient is on FiO2 0.35, PEEP 5, pressure support 8, still running a propofol infusion at RASS minus 3. The question on the round is never whether he is ready to extubate — it is whether anyone has woken him up and tried. The cheapest, most powerful weaning intervention is to stop the sedation and run a breathing trial, and it is missed more often than it is done.^[1]

Hold four numbers and the whole topic holds together: in the WIND cohort of 2729 ventilated patients, 57 per cent wean within a day, 10 per cent are difficult, 9 per cent are prolonged — and 24 per cent never start a weaning process at all — and the marks are won or lost in the difficult and prolonged groups, where the only question is why the respiratory pump cannot beat the load.^[8]

References26Show

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