Weaning from mechanical ventilatory support in the 21st century: Procrustes’ bed, rocket science, or art?

Excerpt

Mechanical ventilatory support of respiratory system dysfunction has been a fundamental part of the provision of care to the critically ill patient for over five decades. Indeed, the development of the specialty of critical care medicine has occurred in parallel with the development of modes of mechanical ventilation and our understanding of its attendant (patho)physiology. Nevertheless, while we have learned a great deal about the use of mechanical ventilation, both for elective purposes in the operating room and for therapeutic purposes in the intensive care unit (ICU), the process of liberating a patient from mechanical ventilation (“weaning”) remains less developed than initiating ventilatory support. We agree with Milic Emili,1 who wrote the Art of Weaning (deciding how and when a patient should begin the weaning process), that its success remains dependent on the experience, skills, and intuition of the treating physician. …