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Resource type: Article

Weaning from the ventilator

What is weaning?

Weaning is the process through which we gradually reduce the amount of support patients receive from the ventilator or breathing machine.Our aim is to reduce the amount of support the patient receives and take the breathing tube out as soon as it is safe to do so.Research has shown that the sooner we do this, the less chance the patient has of developing a chest infection (called a ventilator associated pneumonia) and the less time they generally spend in Intensive Care.

How is it done?

Weaning is routinely carried out by the nurses, who continually assess whether and how well the patient is able to breathe by him or herself with less support from the ventilator or breathing machine. The ventilator or breathing machine has built in sensors and can tell us how effective the patient's own breathing pattern is.The nurses will also assess the patient's vital signs (heart rate, blood pressure, etc), blood oxygen levels (taking samples from the arterial line) and their general level of comfort to make sure that they are coping with less support from the ventilator or breathing machine.The nurses work together with the doctors to decide how quickly this is done and when we can take the breathing (or endotracheal) tube out. The process of taking the tube out is known as "extubation" and this is generally done by the nurses.

How long does weaning take?

Weaning can sometimes be done very quickly and can sometimes take a little longer. This can happen for a number of reasons, including how ill or awake the patient is and how able he or she is to breathe for him or herself e.g. if he or she has become very weak or has developed a pneumonia (or chest infection). Sometimes patients are able to breathe by themselves during the day,but can become tired and need support from the ventilator or breathing machine overnight.

How does having a tracheostomy (or "tracky") help with weaning?

In some cases, the doctors may decide to replace the long breathing (or endotracheal) tube with a shorter tube which is placed in the neck. This tube is known as a tracheostomy (or "tracky"). A tracheostomy (or "tracky") tube is much more comfortable for the patient. It also helps with weaning because patients often require much less of the drugs we use to keep them sleepy and comfortable. They are therefore more awake and more able to breathe with less support from the ventilator or breathing machine.