Archives of Critical Care Medicine

Published by: Kowsar

Weaning the Patient from the Mechanical Ventilator: A Review Article

Parviz Amri 1 , * , Seyedeh Zahra Mirshabani 2 and Seyed Hossein Ardehali 3
Authors Information
1 Anesthesiologist, FCCM, Clinical Research Development Unit, Rouhani Hospital, Babol University of Medical Sciences, Babol, IR Iran
2 Babol University of Medical Sciences, Babol, IR Iran
3 Anesthesiologist, FCCM, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
Article information
  • Archives of Critical Care Medicine: November 2016, 1 (4); e8363
  • Published Online: November 28, 2015
  • Article Type: Review Article
  • Received: October 1, 2015
  • Revised: October 15, 2015
  • Accepted: November 15, 2015
  • DOI: 10.17795/accm-8363

To Cite: Amri P, Zahra Mirshabani S, Hossein Ardehali S. Weaning the Patient from the Mechanical Ventilator: A Review Article, Arch Crit Care Med. 2016 ; 1(4):e8363. doi: 10.17795/accm-8363.

Copyright © 2015, Shahid Beheshti University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Introduction
2. Parameters of Weaning from Ventilator (Recognition of Readiness to Wean)
3. Key Points Regarding the Strategy of Weaning from the Ventilator
4. Protocol of Weaning from the Ventilator
5. Conclusion
6. Future Research on Weaning of Mechanical Ventilation
  • 1. Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O'Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ. 2011; 342: 7237[DOI][PubMed]
  • 2. McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med. 2012; 367(23): 2233-9[DOI][PubMed]
  • 3. Bickenbach J. [Weaning: more than terminating mechanical ventilation]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2016; 51(6): 378-85[DOI][PubMed]
  • 4. Talwar D, Dogra V. Weaning from mechanical ventilation in chronic obstructive pulmonary disease: Keys to success. J Assoc Chest Physicians . 2016; 4(2): 43-9
  • 5. Zein H, Baratloo A, Negida A, Safari S. Ventilator Weaning and Spontaneous Breathing Trials; an Educational Review. Emerg (Tehran). 2016; 4(2): 65-71[PubMed]
  • 6. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995; 274(8): 639-44[PubMed]
  • 7. Pourhassan A, Marzban MS. Incidence, cause and outcomes of ventilator associated pneumonia in the medical intencive care unit. J Urmia Nurs Mid Faculty. 2013; 11(7): 483-90
  • 8. Jabbari A, Alijanpour E, Amri Maleh P, Heidari B. Lung protection strategy as an effective treatment in acute respiratory distress syndrome. Caspian J Intern Med. 2013; 4(1): 560-3[PubMed]
  • 9. Amri maleh P, Taghavi Y, Solimanian S. Aspiration pneumonitis after seizure in apatient undergone cesarean section: a case report. J GorganUni Med Sci. 2012; 14(2): 119-23
  • 10. Amrimaleh P. Airway pressure release ventilation (APRV) for the treatment of severe life-threatening hypoxia in ARDS patients. J GorganUni Med Sci. 2014; 16(2): 131-4
  • 11. Nicbakhsh N, Amri Maleh P, Monadi M, Bijani A, SHarbati F. Prediction of patient's mortality rate of intensive care unit based on apache iv. J Urmia Nurs Mid Faculty. 2016; 14(2)
  • 12. Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996; 335(25): 1864-9[DOI][PubMed]
  • 13. Eskandar N, Apostolakos MJ. Weaning from mechanical ventilation. Crit Care Clin. 2007; 23(2): 263-74[DOI][PubMed]
  • 14. Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000; 161(5): 1530-6[DOI][PubMed]
  • 15. Girard TD, Ely EW. Protocol-driven ventilator weaning: reviewing the evidence. Clin Chest Med. 2008; 29(2): 241-52[DOI][PubMed]
  • 16. Stroetz RW, Hubmayr RD. Tidal volume maintenance during weaning with pressure support. Am J Respir Crit Care Med. 1995; 152(3): 1034-40[DOI][PubMed]
  • 17. Sassoon CS, Te TT, Mahutte CK, Light RW. Airway occlusion pressure. An important indicator for successful weaning in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1987; 135(1): 107-13[DOI][PubMed]
  • 18. Karthika M, Al Enezi FA, Pillai LV, Arabi YM. Rapid shallow breathing index. Ann Thorac Med. 2016; 11(3): 167-76[DOI][PubMed]
  • 19. MacIntyre N. Ventilator discontinuation process: evidence and guidelines. Crit Care Med. 2008; 36(1): 329-30[DOI][PubMed]
  • 20. Tobin MJ, Jubran A. Meta-analysis under the spotlight: focused on a meta-analysis of ventilator weaning. Crit Care Med. 2008; 36(1): 1-7[DOI][PubMed]
  • 21. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991; 324(21): 1445-50[DOI][PubMed]
  • 22. Rivas-Salazar RJ, Baltazar-Torres JA, Arvizu-Tachiquin PC, Moreno-Lopez I, Zamora-Varela S, Cano-Oviedo AA, et al. [Threshold value of f/Vt index for predicting successful weaning from mechanical ventilation in active smokers]. Rev Med Inst Mex Seguro Soc. 2016; 54(4): 414-20[PubMed]
  • 23. Aubier M, Murciano D, Lecocguic Y, Viires N, Jacquens Y, Squara P, et al. Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure. N Engl J Med. 1985; 313(7): 420-4[DOI][PubMed]
  • 24. Manthous CA, Schmidt GA, Hall JB. Liberation from mechanical ventilation: a decade of progress. Chest. 1998; 114(3): 886-901[PubMed]
  • 25. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008; 371(9607): 126-34[DOI][PubMed]
  • 26. Mehta S, Meade M, Burry L, Mallick R, Katsios C, Fergusson D, et al. Variation in diurnal sedation in mechanically ventilated patients who are managed with a sedation protocol alone or a sedation protocol and daily interruption. Crit Care. 2016; 20(1): 233[DOI][PubMed]
  • 27. Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, et al. Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med. 2008; 177(2): 170-7[DOI][PubMed]
  • 28. Laghi F, D'Alfonso N, Tobin MJ. Pattern of recovery from diaphragmatic fatigue over 24 hours. J Appl Physiol (1985). 1995; 79(2): 539-46[PubMed]
  • 29. Esteban A, Alia I, Ibanez J, Benito S, Tobin MJ. Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest. 1994; 106(4): 1188-93[PubMed]
  • 30. Esteban A, Frutos F, Tobin MJ, Alia I, Solsona JF, Valverdu I, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med. 1995; 332(6): 345-50[DOI][PubMed]
  • 31. Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med. 1994; 150(4): 896-903[DOI][PubMed]
  • 32. Burns KE, Adhikari NK, Keenan SP, Meade M. Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: meta-analysis and systematic review. BMJ. 2009; 338[DOI][PubMed]
  • 33. Amri Maleh V, Monadi M, Heidari B, Maleh PA, Bijani A. Efficiency and outcome of non-invasive versus invasive positive pressure ventilation therapy in respiratory failure due to chronic obstructive pulmonary disease. Caspian J Intern Med. 2016; 7(2): 99-104[PubMed]
  • 34. Hendrix H, Kaiser ME, Yusen RD, Merk J. A randomized trial of automated versus conventional protocol-driven weaning from mechanical ventilation following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2006; 29(6): 957-63[DOI][PubMed]
  • 35. Davidson AC, Banham S, Elliott M, Kennedy D, Gelder C, Glossop A, et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax. 2016; 71 Suppl 2-35[DOI][PubMed]
  • 36. Burns KE, Lellouche F, Lessard MR. Automating the weaning process with advanced closed-loop systems. Intensive Care Med. 2008; 34(10): 1757-65[DOI][PubMed]
  • 37. Cohen JD, Shapiro M, Grozovski E, Lev S, Fisher H, Singer P. Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure. Crit Care Med. 2006; 34(3): 682-6[DOI][PubMed]
  • 38. Chao DC, Scheinhorn DJ. Weaning from mechanical ventilation. Crit Care Clin. 1998; 14(4): 799-817[PubMed]
  • 39. Kuo NY, Tu ML, Hung TY, Liu SF, Chung YH, Lin MC, et al. A randomized clinical trial of neurally adjusted ventilatory assist versus conventional weaning mode in patients with COPD and prolonged mechanical ventilation. Int J Chron Obstruct Pulmon Dis. 2016; 11: 945-51[DOI][PubMed]
  • 40. Holets SR, Marini JJ. Is Automated Weaning Superior to Manual Spontaneous Breathing Trials? Respir Care. 2016; 61(6): 749-60[DOI][PubMed]
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments