Mechanical Ventilation Weaning

Expiratory muscle strength independently predicts successful extubation and delayed weaning. Spontaneous breathing trials last at least 30 minutes and may use T-piece, pressure support, or CPAP. The treating intensivist retains discretion over the final extubation decision. All trial sites use a standardized spontaneous breathing trial protocol to reduce centre-level variation. Each additional day of mechanical ventilation is associated with higher morbidity, mortality, and healthcare cost. Mechanical ventilation is associated with early respiratory and abdominal muscle loss in a substantial share of patients. Post-extubation non-invasive ventilation or high-flow nasal cannula is recommended for older patients or those with cardiac or respiratory disease.