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Related Concept Videos

Endotracheal Tube Extubation01:24

Endotracheal Tube Extubation

Endotracheal tube extubation is a critical procedure in weaning patients from mechanical ventilation. It involves physically removing the oral or nasal endotracheal (ET) tube, marking the final step in liberating a patient from ventilatory support.
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals.
Drug Dosing: Obese Patients01:21

Drug Dosing: Obese Patients

In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
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Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
Endotracheal Intubation II: Nursing Management01:17

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Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.
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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Updated: Jun 8, 2026

Inspiratory Muscle Training as an Adjunct to the Treatment of Weaning Failure in Critically Ill Patients: A Practical Guide
04:16

Inspiratory Muscle Training as an Adjunct to the Treatment of Weaning Failure in Critically Ill Patients: A Practical Guide

Published on: January 30, 2026

The difficult-to-wean patient.

Nicolino Ambrosino1, Luciano Gabbrielli

  • 1Cardiothoracic Department, Pulmonary Unit, University Hospital of Pisa, Via Paradisa 2, Cisanello, Pisa, Italy. n.ambrosino@ao-pisa.toscana.it

Expert Review of Respiratory Medicine
|October 7, 2010
PubMed
Summary

Approximately 20% of patients on mechanical ventilation face difficult weaning, often due to reversible factors. Successful weaning depends on patient complexity, hospital resources, and early physiotherapy interventions.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Rehabilitation Medicine

Background:

  • Difficult weaning affects up to 20% of patients requiring mechanical ventilation, prolonging their stay and increasing morbidity.
  • Prolonged mechanical ventilation can lead to complications like myopathy, neuropathy, body composition changes, and depression.
  • Management of difficult-to-wean patients occurs in specialized respiratory intermediate-care units or weaning centers.

Purpose of the Study:

  • To outline the causes, consequences, and management strategies for patients experiencing difficult weaning from mechanical ventilation.
  • To highlight the critical role of physiotherapy and multidisciplinary approaches in weaning protocols.
  • To identify factors influencing successful weaning outcomes.

Main Methods:

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  • Review of common causes of difficult weaning, including respiratory, cardiac, neuromuscular, neuropsychological, and metabolic factors.
  • Description of clinical consequences of prolonged mechanical ventilation.
  • Discussion of two primary weaning protocols: progressive ventilator support reduction and extended spontaneous breathing trials.
  • Emphasis on the integration of physiotherapy into weaning protocols.

Main Results:

  • Difficult weaning is multifactorial, stemming from reversible patient-related issues and complications of prolonged ventilation.
  • Specialized units and defined protocols are crucial for managing these complex patients.
  • Early and consistent physiotherapy is a key component for improving weaning success.

Conclusions:

  • Successful weaning from mechanical ventilation requires addressing reversible causes, managing complications, and optimizing patient-specific care.
  • Multidisciplinary collaboration, specialized units, and adherence to evidence-based protocols, including early physiotherapy, are essential for improving outcomes.
  • Patient autonomy and family preparation are vital for successful discharge and long-term management.