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Weaning from mechanical ventilation.

In this review, traditional weaning parameters, integrative indexes, and experimental methods of predicting weaning outcomes have been reviewed. All have limitations; however, judicious application of these parameters may guide clinical decisions regarding timing of weaning trials. Of the parameters reviewed, the RSBI has several advantages and may identify patients who are candidates for weaning. Likewise, application of tools such as the daily screen or implementation of multidisciplinary weaning teams may assist clinicians in weaning patients earlier in their ICU course. Most patients will be successfully extubated after a single SBT, and weaning methods that focus on sequential decrements in ventilator support appear to needlessly prolong ventilation. However, for patients who fail, identification of potential causes of continued ventilator dependence should focus on the various pathophysiological causes outlined. Although a number of patients will require prolonged ventilator support beyond the critical care setting, the growing experience with this population demonstrates that a large percentage have favorable outcomes.