From the Guidelines
The optimal method for ventilator weaning is through the use of spontaneous breathing trials (SBTs), which have been shown to be safe and effective in reducing time to extubation compared to gradual weaning approaches.
Key Components of Ventilator Weaning
- SBTs should be conducted daily to identify patients ready for liberation from mechanical ventilation 1
- Ventilator liberation protocols can be used to systematically apply evidence to practice and reduce variability in assessing readiness for liberation 1, 2
- Inspiratory pressure augmentation during SBTs can be used, but there is no consensus on the optimal approach, with options including no augmentation (T-piece or CPAP) or modest augmentation (pressure support of 5-8 cm H2O) 2 ### Implementation of Ventilator Weaning
- Readiness criteria should be established before conducting an SBT, and patients who meet these criteria should be given the opportunity to demonstrate sustainable ventilation and oxygenation without mechanical support 1, 2
- Noninvasive ventilation can be considered immediately after extubation to support patients who may require ongoing respiratory support 2
- Rehabilitation protocols and cuff leak tests can also be used to support ventilator weaning, but the evidence for these approaches is less clear 3, 4
From the Research
Optimal Method for Ventilator Weaning
The optimal method for ventilator weaning is a topic of ongoing research and debate. Several studies have investigated different approaches to weaning, including:
- Pressure support ventilation (PSV) 5, 6, 7
- T-piece trials 5, 6, 7
- Synchronized intermittent mandatory ventilation (SIMV) 7
- Proportional assist ventilation (PAV) 8
- SmartCare 8
- Automatic tube compensation 8
- Continuous positive airway pressure (CPAP) 8
- Adaptive support ventilation (ASV) 8
- Neurally adjusted ventilatory assist (NAVA) 8
Comparison of Weaning Methods
Studies have compared the effectiveness of these methods, with some finding that:
- PSV and T-piece trials are superior to SIMV 5, 7
- PAV and SmartCare are effective methods for increasing weaning success 8
- PAV has a superior effect in reducing the proportion of patients requiring re-intubation and mortality 8
- PSV has a lower number of weaning failures compared to T-piece and SIMV 7
Clinical Considerations
When considering the optimal method for ventilator weaning, clinicians should take into account: