Methods of Weaning People Off Mechanical Ventilation

When a person is ill and cannot breathe properly for himself, a doctor may place him on a mechanical ventilator. This machine is also known as a respirator or a breathing machine. The doctor fits a tube into the patient's mouth and down his throat through the windpipe. The ventilator pushes air into the patient's lungs, which can contain more oxygen than normal, if necessary, and therefore breathes for the patient. A ventilator is a temporary measure to keep the patient alive and breathing until he heals and is able to breathe for himself. As the ventilation tube increases the risk of complications, such as infections and damage to the lungs, a doctor weans the patient off the ventilator as soon as it is safe to do so.

Autonomy

• No single correct method exists for all patients on mechanical ventilation. Instead, individual hospitals or healthcare organizations may develop their own procedures for doctors to follow. Another possibility is that the choice can fall to the doctor as to what exactly to do with a particular patient. This type of autonomy is flexible enough to take into account that each patient and each medical condition is different, and that different people can respond differently when they come off mechanical ventilation. Conversely, a written protocol, which was developed using all the available information, could potentially protect a patient from ill-judged choices by a doctor.

Factors

• A doctor can take a variety of indicators into account when she decides whether a patient is ready to come off the ventilator. She needs to know if the condition that originally caused the problems in breathing is under control and that the patient can attempt to take his own breaths effectively. She can also check that his blood has safe levels of pressure and other indicators of health, such as safe blood gas concentrations. The patient should be at rest, since movement and stress can hinder respiration.

Test Period

• After the doctor is sure that the patient can attempt to breathe on his own, she can disconnect the ventilator and let him clear his throat and take some breaths. She can also preface this step with a slow reduction in the number of artificial breaths per minute of the ventilator, and regularly check blood and breaths every 15 or 30 minutes to ensure he adapts to the lower level of respiration. After she disconnects the machine, an example test period off the ventilator ranges from 30 minutes to an hour and a half. If the patient should have trouble clearing his throat or breathing, then the doctor can put him back on the ventilator. During the test period, any sedative drugs the patient is under should be as light as possible to prevent depressing the respiratory system.

Longterm Ventilation

• Occasionally, a patient does not respond well to weaning and he has to remain on the ventilator for weeks or months. The doctor may then have to perform a tracheostomy and place the tube through a hole in the throat rather than through the mouth. She can repeat the weaning process whenever the patient is receptive to the procedure.