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  1. Identify patients ready for ventilator discontinuation.

  2. Discuss the important role of the spontaneous breathing trial (SBT) to determine extubation readiness.

  3. Contrast the approaches used to wean patients from ventilatory support.

  4. List causes of a failed SBT.

  5. Discuss the role of sedation in the ventilator discontinuation process.

  6. Discuss the use of ventilator discontinuation protocols.

  7. Discuss criteria used to indicate readiness for extubation.

  8. Discuss issues related to prolonged mechanical ventilation (PMV) and chronic critical illness (CCI).


The ultimate goal of mechanical ventilation is ventilator discontinuation. Most patients can be liberated from the ventilator when the physiologic reason for ventilatory support is reversed. In others, this may be a more prolonged process and associated with chronic critical illness (CCI). Because of their underlying disease process, some patients may become chronically ventilator-dependent (eg, those with neuromuscular disease). The ventilator discontinuation process has been categorized as simple (patients who successfully extubate after the first spontaneous breathing trial (SBT); estimated at about 70% of ventilated patients), difficult (patients who fail the initial SBT and require up to three SBTs or as long as seven days from the first SBT to achieve successful ventilator liberation; estimated at about 15% of mechanically ventilated patients), and prolonged (patients who fail at least three SBTs or require more than 7 days from the first SBT to achieve successful ventilator discontinuation; estimated at about 15% of mechanically ventilated patients). This chapter addresses issues defining readiness for ventilator discontinuation, assessments that predict readiness for ventilator liberation, approaches to liberation from ventilator support, use of protocols, automated weaning, and assessment for extubation. The content of this chapter is written to be consistent with evidence-based clinical practice guidelines (Table 16-1).

Table 16-1AACCP-SCCM-AARC 2001 Ventilator Weaning/Discontinuation Guidelinesa

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