Weaning from mechanical ventilation: current controversies.

Abstract

As an acute episode of respiratory failure resolves for the patient who is receiving mechanical ventilation, the sometimes difficult task of resuming spontaneous ventilation begins. The resumption of spontaneous ventilation, commonly referred to as weaning, is often difficult for the patient with preexisting lung disease. The purpose of this article is to explore the current controversies related to weaning patients from mechanical ventilation. Patients with chronic obstructive pulmonary disease are used as examples, providing the background for understanding weaning in difficult cases. Weaning is conceptualized as a process of three phases: preweaning, weaning, and extubation. Important considerations during each phase are examined.