New techniques for weaning difficult patients from mechanical ventilation

This article compares the weaning of challenging patients from mechanical ventilation to an exercise training program experienced by many athletes. Physically, the importance of the correction and maintenance of chronic health issues, nutrition, and hydration are explored. Psychologically, the degree of preparedness by both the patient and the health care team is presented. Parameters for predicting readiness to wean that include both objective and subjective indices are gaining more support; two tools for weaning are offered. During the weaning process, reconditioning of the respiratory muscles can be promoted through endurance or strengthening exercises or a combination of both. The quality and quantity of exercise performed must be closely monitored to prevent respiratory muscle fatigue or atrophy. Newer modes of ventilation, including pressure support ventilation, mandatory minute ventilation, and continuous flow, decrease the work of breathing, promote ventilator/patient synchrony, and provide a more dynamic weaning process. All of these modes promote exercise, and augment the physical and psychological components of weaning. Nursing considerations for successful weaning are offered.