Techniques of weaning

Important studies in the 1990s established that the mode of ventilation has a major influence on the success of weaning. Brochard et al55 compared weaning by pressure support (PS), T-piece trials, and synchronised intermittent mandatory ventilation (SIMV) in a group of patients who had failed to wean and in whom it was predicted that weaning would be problematic. Over a period of 28 days SIMV was clearly inferior to the other techniques, with an advantage in favour of the PS group. This study also emphasised the importance of a weaning protocol. The Spanish Lung Failure Collaborative Group reported contrasting findings.56 While SIMV was clearly less favourable, T-piece weaning was advantageous overall. Although both studies showed that SIMV was disadvantageous, the explanation for the differing findings between PS and T-piece weaning may relate to differences in study design. For example, the duration of mechanical ventilation was different between the two studies, with fewer longer term patients in the Spanish study.

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