Weaning from mechanical ventilation: approach for the internist

Resumo

Weaning from mechanical ventilation is a challenge. Its prolongation is related to increased mortality. Studies have demonstrated that traditional objective criteria used are not able to shorten this time for discontinuation of mechanical ventilation. The aim of this study is to review the strategies that have been proposed and that can be used by the internist to shorten the weaning process. The judicious and systematized clinical judgment in the weaning process seems to be critical to decrease the time of weaning from mechanical ventilation. A cause of failure in weaning process should be systematically reviewed by the internist (airway and respiratory tract dysfunction, cardiac, neurological, endocrine and metabolic dysfunction). A protocol for weaning and sedation also seems crucial to shorten weaning. For the weaning process, bedside clinical follow-up by a multidisciplinary team is essential, taking various aspects into account, not only traditional objective criteria. With this approach strategy it is possible to reduce the duration of mechanical ventilation.