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What Are the Different Methods for Ventilator Weaning?

Patients on ventilators must gradually get used to breathing without one.
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  • Written By: Erin J. Hill
  • Edited By: Bronwyn Harris
  • Last Modified Date: 15 April 2014
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For anyone on a ventilator, the weaning process can be a happy, stressful, and sometimes scary event. Everyone reacts differently to the prospect of ventilator weaning; ranging from short-term patients who can’t wait to get up and moving again, to long-term patients who are hesitant about attempting to breathe on their own again with no intervention.

Before attempting any ventilator weaning method, it is important to ensure that the patient is ready. This will include curing or stabilizing the illness that led to ventilation in the first place; as well as readying the patient emotionally for this important step. In some cases, counseling is implemented as a coping tool. Some patients may also require physical or speech therapy to learn exercises used to strengthen the neck and chest muscles used for breathing.

Once all the groundwork is laid, a patient may be ready to begin ventilation weaning. The first step usually includes a spontaneous breathing test to allow the patient to practice breathing again, as well as to gauge lung strength. This is done using a device called a T-tube, inserted into the ventilator to allow patients to take breaths on their own. This device has its drawbacks, however. Many patients will receive an inaccurate reading because the T-tube is much more difficult to breathe through than it would be to breathe independently.

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Assuming the T-tube test goes as planned, the patient will be permitted to use one of two ventilator weaning devices. The first of these is called synchronized intermittent mandatory ventilation. This method is conducted by placing a small valve directly into the ventilator. The valve allows a patient to take independent breaths while still providing mandatory breaths as backup. This tactic can be counterproductive, however, because it sometimes provides mandatory breaths directly after a patient takes an independent breath. This can cause too much airway pressure and lead to complications.

Another method used for ventilator weaning is called pressure supported ventilation. This is similar to the synchronized intermittent mandatory ventilation, but it allows the patient to control the rate at which independent and mandatory breaths are taken and administered. This prevents the problems associated with the synchronized method and is preferred by many physicians.

While many doctors opt for weaning patients off the ventilator, there are those who prefer to allow a patient to try breathing on his own “cold turkey.” A spontaneous breathing test will still generally be administered ahead of time, followed by the complete removal of the ventilator tubes. This method is often effective for patients who are fully recovered from illness, young patients, and short-term patients. It is not usually recommended when a patient has been ventilated for a long time or in elderly patients. In some cases, the ventilator will have to be reinserted; a process that can strain the health of weak patients.

In any case, ventilator weaning should be done with care. It is much less harmful to allow a nervous or weak patient to remain on a ventilator than to rush weaning before it’s time. Ensuring that each patient is emotionally stable, strengthened, and nourished with solid foods will greatly increase the chances of success.

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