ABSTRACT
To this end, new strategies and protocols for weaning from mechanical ventilation are clearly needed in the daily practice of healthcare.
While unnecessary delays in withdrawing mechanical ventilation can increase the risk of complications, prolong ICU stay and significantly amplify healthcare costs, premature attempts at withdrawal of mechanical ventilation might lead to development of severe distress, hamper the recovery process and further delay weaning.4 Physicians often fail to recognize patients who may already be ready for extubation. Studies among patients who are
The chapter presents the state of the art of the weaning process including use of protocols derived from mechanical ventilation in patients with chronic obstructive pulmonary disease or those who experienced acute respiratory failure. The weaning process is a delicate time in the medical history of a patient who survives an acute episode of respiratory failure and spends a period of time under mechanical ventilation. In fact, during the period of mechanical ventilation, there are a lot of implications that are currently somehow underestimated in daily medical practice: occupation of beds, healthcare costs, burden for the families and for the patients themselves. Although these occurrences are quite common and critical, there are no clear guidelines on the minimal criteria required for assessing the correct weaning time for different diseases, or on the need for a screening test prior to a spontaneous breathing test. It is also crucial to identify the patients who can be considered possible successful responders to the weaning process. A careful review of the literature shows the crucial role of the respiratory therapist in the multidisciplinary team (physician, nurse, respiratory therapist and family as well), who should be involved in such a delicate process. In general, weaning should start early in patients under mechanical ventilation and it has been observed that the majority of patients can be successfully weaned on the first attempt. The spontaneous breathing test is the major diagnostic test to determine if patients can be successfully extubated. However, there are too many aspects that still need to be investigated. Therefore, the specific need of availability of clear weaning protocols is stressed and recommended.
