Introduction

Weaning is the process whereby mechanical ventilation is gradually withdrawn and the patient resumes spontaneous breathing to allow eventual successful extubation. However, there is no universally accepted definition of successful weaning. Proposed definitions specify varying periods of sustained spontaneous breathing following discontinuation of mechanical ventilatory support, and some definitions require successful extubation as a condition. None of these definitions note the time at which the weaning process starts. With widespread use of patient-assisted ventilatory modes, it has become difficult to stipulate when mechanical ventilation changes from primary support to assistance in weaning. Hence the rate of weaning failure can range from 20 to 70 per cent, depending on the definition used for weaning success. Failure to wean is distinct from the need for continuing tracheal intubation, for example for airway protection.

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