ABSTRACT
A vast majority of patients can be weaned from mechanical ventilation without difficulty. Although there is no consensus on the definition of a “difficult-to-wean” patient, the period of 14 to 21 days is generally accepted as “ventilator dependent” (1). There is a small population of patients who require prolonged mechanical ventilation (PMV) because of pulmonary, cardiac, or neuromuscular disease (NMD) or because of other multisystem problems. This population consumes a large section of the overall ICU patient days and about 50% of the ICU budget (2). The number of such patients has increased in recent years (3), a trend that is likely to continue. The ICU is an inappropriate environment for patients requiring PMV, as weaning is time consuming and involves more than the choice of the best approach to ventilation for a particular patient (4,5). A recent editorial entitled “The Challenge of Prolonged Mechanical Ventilation: A Shared Global Experience” (6) stressed the need for an international consensus, based on evidence, position papers, and international conferences.
