Authors' objectives:

Because mechanical ventilation incurs significant morbidity, mortality, and costs, and because premature extubation as well as delayed extubation can cause harm, weaning that is both expeditious and safe is highly desirable. This report aims determine whether the current literature elucidates when and how weaning should begin, proceed, and end.

Authors' recommendations: This study reviewed 154 articles. For stepwise reductions in mechanical support, pressure support mode or multiple daily T-piece trials may be superior to synchronized intermittent mandatory ventilation. For trials of unassisted breathing, low levels of pressure support may be beneficial. There may be substantial benefits to early extubation and institution of noninvasive positive pressure ventilation before patients are ready to breathe without mechanical assistance. The value of differing modes as reflected in these studies depends on the thresholds for initiating, progressing through, and terminating weans in the specific study protocols. Unfortunately, these thresholds involve more than objective data and appear to be related to physician judgment.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/mechsumm.htm

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)