WEANING FROM MECHANICAL VENTILATION

Use of mechanical ventilation is associated with several major complic ations despite its lifesaving potential, Timely discontinuation of mec hanical ventilation is critical to control of duration of intensive ca re unit stay and reduction of complications associated with mechanical ventilation, Difficulty in discontinuation (or weaning) of patients f rom mechanical ventilatory support is in part attributable to inadequa te understanding of the mechanisms responsible for unsuccessful outcom e and a lack of guidelines regarding the optimal approach to the proce ss of discontinuation of mechanical ventilation, For the first time, r esults from prospective, randomized, multicenter trials are available comparing common means of discontinuation of mechanical ventilation, I n addition, the physiologic basis for a weaning strategy in mechanical ventilation is also coming into better focus, Two recent trials of we aning suggest different optimal modes, one favoring T-piece trials and the other supporting the use of pressure support ventilation. In eith er case, the above weaning techniques appear to be superior to intermi ttent mandatory ventilation In separating patients from mechanical ven tilatory support, Based on available clinical trials, pressure support ventilation or T-piece trials appear to he the preferred methods for discontinuation of mechanical ventilatory support, A method using a si mple T-piece trial technique is described.