[Weaning from mechanical ventilation: which strategies are useful?]

During acute respiratory failure, intubation and invasive mechanical ventilation may be life saving procedures. However, with increasing time on the ventilator, the rate of complications increases and prolonged mechanical ventilation is associated with increased morbidity, mortality and high ICU cost. Since the weaning period accounts for 40% of the overall ventilation period, optimizing weaning is mandatory to shorten mechanical ventilation. Various concepts to facilitate weaning have been proposed and there is an ongoing debate about the most effective methods. These include an early screening of weaning readiness based on established criteria, the choice of the concept of ventilation and ventilator modes, the use of weaning protocols, "closed loop" automated ventilation and weaning. This article describes the relevance of the different ventilator strategies that are applied during weaning from mechanical ventilation.