Discontinuing Mechanical Ventilation

Discontinuing Mechanical Ventilation provides clear, step-by step instructions on how to liberate or “wean” the patient from the ventilator. It explains how to determine when the patient is ready to begin the weaning process, how to perform a spontaneous breathing trial, and how to determine if the patient is ready for extubation, including such considerations as whether the patient is at risk for post-extubation laryngeal edema; whether the patient will be able to effectively clear secretions from the airways following extubation; and determining if the patient has a “difficult airway” should the need for re-intubation arise. The chapter also provides a step-by-step approach to the difficult-to-wean patient, covering topics such as how to assess ventilatory ability and demand; determine the cause(s) of increased demand, impaired ability, or both; treat the causes of increased demand and impaired ability; and determine when to perform a tracheostomy.