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. For acutely hospitalized adults ventilated for more than 24 hours, ATS/CHEST suggests management with a ventilator-liberation protocol. Use a standardized daily readiness assessment rather than waiting for a dramatic change or a perfect laboratory value. Delayed assessment is a modifiable clinical problem, not simply an unavoidable feature of critical illness.