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Stages of Mechanical Ventilation Weaning Mechanical ventilation weaning is a critical aspect of respiratory management and should be planned ahead of time. As the consequences of prolonged mechanical ventilation are discovered and reported, it becomes clear that knowing when to stop mechanical ventilation is just as important as knowing when to start. Weaning is divided into stages to help the clinician effectively determine and treat specific weaning-related problems. Specifically, weaning may be divided into seven stages: The first stage, or the pre-weaning phase, is the period during which attempts at weaning are not made (i.e. indications for intubation are still present). In the second stage, the physician believes that a patient is ready for weaning. This stage may also be called a “clinical suspicion� stage. This is a critical step because failure to recognize a patient who is ready for weaning may lead to unnecessary prolongation of mechanical ventilation and unwarranted exposure of patients to the hazards of mechanical ventilation. For a more in-depth discussion of the basics of ventilatory support, please visit Medical-ELearning. The third stage entails measurement and interpretation of physiologic predictors for weaning. The physician should be able to take essential measurements and be able to effectively use the results to determine a patient’s readiness for weaning. The fourth stage is trial of weaning. The patient receives decreased ventilatory support, either gradually or abruptly.


In the fifth stage, the patient who underwent a successful trial of weaning may be extubated. Mechanical ventilation may be restarted in the patient with failure of weaning. After extubation, the sixth stage involves the use of non-invasive mechanical ventilation, such as continuous positive airway pressure or CPAP. This does not apply to all patients. The seventh stage is reintubation typically followed by resumption of mechanical ventilation. Hours before weaning are reattempted. This is done to permit recovery of the respiratory muscles. Mechanical ventilation weaning is as much an art as it is a science. The physician’s subjective assessment plays a big role in determining when weaning should be started. After deciding when a patient can be weaned from the ventilator, appropriate steps should be taken to ensure its success.


Stages of Mechanical Ventilation Weaning