Weaning of mechanical ventilation

The weaning of mechanical ventilation is the process during which one more or less gradually decreases the proportion of the respiratory work provided by the respirator in order to check the capacity of a patient to be breathed by itself or to allow the patient to increase the endurance of his respiratory muscles. The final goal being to make a total autonomy respiratory to the patient within best the deadlines.

General information

Although the experts get along in general on some great principles, there does not exist protocol universally recognized in this field and no approach was the proof of its superiority on the others. The object of this article will thus be limited to present the various existing approaches.

Methods of weaning

Ventilation assisted/controlled intermittent (Synchronized Intermittent Obligatory Ventilation)
spontaneous Ventilation + inspiratory Assistance + PEP
spontaneous Breathing on part in " T" or box for tracheotomy

Criteria of weaning

Several criteria were proposed to predict the success of a weaning. Some constitute " tools of reflection clinique" interesting but none makes it possible to predict with certainty the exit of a weaning.

The measurement of the inspiratory force seems very interesting, because a value smaller than 20 cmH2O indicates to it near certainty of a reintubation. Approximately 30% of the patients with an inspiratory force higher than 20 cmH2O will fail despite everything the extubation.

Another criterion suggested is the report/ratio of the respiratory frequency on current volume in liter during spontaneous breathing.

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