Mechanical Ventilation Weaning

Invasive mechanical ventilation is life-sustaining, but its harms accumulate with exposure. Endotracheal intubation increases the risk of airway injury and ventilator-associated pneumonia; sedation contributes to delirium and immobility; and controlled ventilation unloads the diaphragm until ventilator-induced diaphragm dysfunction and ICU-acquired weakness make independent breathing harder. The longer unnecessary support continues, the more difficult separation may become. The counter-risk is premature separation. Reintubation is associated with excess mortality, so the goal is not to remove support at the first isolated improvement. The goal is to identify the earliest point at which the patient can sustain spontaneous breathing safely, then test that ability in a controlled way. “Weaning” describes the process of reducing dependence on the ventilator; “liberation” includes successful separation and extubation. Most patients should undergo a low-threshold readiness screen every day rather than wait for a dramatic change or a perfect laboratory value. In the WEAN SAFE cohort, only 65% of patients had been successfully weaned by day 90, and 22.4% could have had an earlier separation attempt. Delayed assessment is therefore a modifiable clinical problem, not simply an unavoidable...