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Weaning from mechanical ventilation

What's new

Updated 2024 AARC guidelines on spontaneous breathing trials for weaning from mechanical ventilation.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of weaning from mechanical ventilation are prepared by our editorial team based on guidelines from the American Association for Respiratory Care (AARC 2024), the Korean Society of Critical Care Medicine (KSCCM 2024), the European Society of Intensive Care Medicine (ESICM 2020), the Society of Critical Care Medicine (SCCM 2018), the American ...
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Screening and diagnosis

Assessment for discontinuation: as per BTS/ICS 2016 guidelines, assess patients with hypercapnic respiratory failure daily for readiness to begin weaning from mechanical ventilation.
B
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Diagnostic investigations

Evaluation for ventilation dependence: as per AARC 2024 guidelines, avoid using the Rapid Shallow Breathing Index to determine readiness for spontaneous breathing trials.
D

Diagnostic procedures

Cuff-leak test: as per KSCCM 2024 guidelines, consider performing a cuff leak test at the discretion of the clinician before extubation of adult patients receiving mechanical ventilation at high risk for post-extubation stridor.
C

Respiratory support

Spontaneous breathing trial: as per AARC 2024 guidelines, consider performing spontaneous breathing trials with or without low-level pressure support ventilation (≤ 8 cmH₂O).
C
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  • Noninvasive ventilation

  • Intermittent mandatory ventilation

  • Mechanical ventilation

Medical management

Corticosteroids: as per KSCCM 2024 guidelines, administer corticosteroids before extubation to prevent post-extubation stridor and re-intubation in mechanically ventilated adult patients failed a cuff leak test.
B

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Nonpharmacologic interventions

Inspiratory muscle training: as per KSCCM 2024 guidelines, consider providing inspiratory muscle training to increase the success rate of weaning from mechanical ventilation in critically ill adult patients on mechanical ventilation.
C

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  • Rehabilitation

Therapeutic procedures

Extubation: as per KSCCM 2024 guidelines, administer high-flow nasal cannula over conventional oxygen therapy for successful weaning from mechanical ventilation in adult patients undergoing planned extubation.
B
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Quality improvement

Liberation protocols: as per KSCCM 2024 guidelines, use a mechanical ventilation weaning protocol in critically ill patients on mechanical ventilation.
B