Ventilator Weaning and Extubation  
 
Overview 
Ventilator weaning is the process of reducing and discontinuing mechanical ventilatory support. Extubation is removal of the endotracheal tube once the patient can maintain ventilation and airway protection. 

Physiology of Weaning 
Successful spontaneous breathing depends on balance between respiratory load, muscle capacity, gas exchange, and neurologic drive. 

Readiness Criteria for Weaning 
Clinical stability, adequate oxygenation, acceptable ventilation, and supportive respiratory mechanics should be present. 

Spontaneous Breathing Trial (SBT) 

Key test of readiness using low pressure support, CPAP, or T-piece for 30–120 minutes. Failure signs include tachypnoea, hypoxemia, tachycardia, distress, or acidosis. 

Weaning Strategies 
Daily sedation interruption, protocolized weaning, and daily SBTs are preferred over gradual support reduction. 

Extubation Readiness 
Patient must pass SBT and demonstrate airway protection, adequate cough, manageable secretions, and no anticipated obstruction. 

Post-Extubation Monitoring 
Monitor closely for respiratory distress, hypoxemia, stridor, or secretion burden, especially in high-risk patients. 

Causes of Extubation Failure 
Upper airway obstruction, muscle fatigue, secretions, cardiac dysfunction, or residual sedation. 
 
Key Points
Assess readiness daily.
SBT is central.
Extubation requires airway protection.
Early recognition of failure saves lives.