> process of withdrawing mechanical ventilatory support and transferring the work of

breathing from the ventilator to the patient.

🚩 Before weaning, the patient should have recovered from the acute phase of the
disease leading to mechanical ventilation and be able to assume adequate
spontaneous breathing

Assess a patient’s readiness for spontaneous breathing, determined largely by

resolution of the underlying process causing respiratory failure. Important criteria
indicating a patient may be ready for extubation:

underlying disease process has improved

patient is awake and largely off sedative medications
Fio2 ≤0.5, PEEP <8 cmH2O, SaO2 >88%, stable hemodynamics, and
manageable respiratory secretions with adequate cough.

These criteria should be assessed daily, and if achieved, patients should have a
spontaneous breathing trial (SBT)—a maneuver wherein positive pressure is set to a
minimum to compensate for endotracheal tube resistance (usually 5–7 cmH2O) and
the patient breathes spontaneously from 30–120 min. A patient “passes” the SBT if
they appear comfortable overall (no marked anxiety or diaphoresis) and have a
respiratory rate <35,
SaO2 >90%, SBP between 90 and 180 mmHg
✅ the PaCO2 should be 35- 45 mm Hg and the pH 7.35 - 7.45 (for COPD patients,
the PaCO2 may be around 50 mm Hg with a pH near 7.35)
✅ the vital capacity and spontaneous tidal volume that correlate with
successful weaning are 10 mL/kg and 5 mL/kg, respectively

The f/VT index reflects the degree of rapid shallow breathing.

✅ An f/VT index of 100 breaths/min/L correlates with weaning success.
✅ For a successful weaning outcome, the patient’s minute ventilation should be less
than 10 L/min with acceptable
blood gases.

The generally accepted oxygenation weaning criteria include

✅a PaO2 of greater than 60 mm Hg (or SaO2 . 90%) on an FIO2 of 0.40 or less
✅ a PaO2/FIO2 index greater than 150 mm Hg
✅ an intrapulmonary shunt (QS/QT) of less than 20%
✅ alveolar-arterial oxygen tension gradient (P(A-a)O2) less than 350 mm Hg at an
FIO2 of 100%

WEANING PROCEDURE
spontaneous breathing trial (SBT) is the major diagnostic test to determine if patients
can be successfully extubated and weaned from mechanical ventilation.
✳ An evaluation of a patient’s readiness for weaning from MV and extubation.
Spontaneous breathing may be augmented with
low-level (</=8 cm H2O) of pressure support, CPAP, or automatic
tube compensation (ATC). SBT may last up to 30 minutes.

✳ synchronized intermittent mandatory ventilation (SIMV):

A mode of ventilation that permits spontaneous breaths between
ventilator breaths. The ventilator breaths are synchronized (mandatory breaths that
may come slightly sooner or later) to coincide with the patient’s inspiratory efforts.
weaning success: Absence of ventilatory support 48 hours following the extubation.
weaning in progress: An intermediate category (between
weaning success and weaning failure) for patients who are
extubated but continue to receive ventilatory support by NIV
Weaning failure is either the failure of spontaneous breathing trial (SBT) or the need
for reintubation within 48 hours
following extubation.