Weaning newborns from mechanical ventilation

While there is a relative consensus as to whether mechanical ventilation should be initiated, the management of babies during recovery from respiratory failure remains largely subjective and is predominantly determined by institutional or individual practices or preferences. This can lead to babies either being left on the ventilator too long, or extubated too hastily, thus requiring repeated re-intubation. The current scientific literature fails to provide a uniform view of the most appropriate way to wean babies from mechanical ventilation. This might stem from a lack of understanding of the relative merits of the different techniques of discontinuing mechanical ventilation, given the availability of a variety of primary ventilatory modes which were not available to a neonatal population before, and limited research into the pathophysiological mechanisms responsible for an unsuccessful extubation. The purpose of this paper is to review the physiological, mechanical, and clinical principles of weaning, and to highlight areas still in need of investigation.