自主呼吸实验时间对老年COPD患者机械通气撤机的影响

目的观察延长自主呼吸实验(spontaneousbreathing trail,SBT)时间,对老年COPD机械通气患者撤机成功率的影响。方法选择我科从2015年10月—2017年11月需要有创机械通气的慢性阻塞性肺疾病急性加重期(AECOPD)患者,随机分为2 hSBT组(常规组)和8 hSBT组(试验组),比较两组的性别、年龄、SBT前急性生理与慢性健康评分(acutephysiology and chronic healthevaluationⅡ,APACHEⅡ)、通气时间、氧合指数、呼吸浅快指数(RSBI)、SBT和撤机成功率、住ICU时间。结果共入组80例患者,常规组40例,试验组40例。两组间性别、年龄、SBT前APACHEⅡ评分、通气时间、氧合指数、RSBI比较差异无统计学意义(P0.05)。常规组的患者SBT成功率(87.5%)显著高于试验组(65.00%)(P=0.036)。常规组患者的撤机成功率(71.43%)则显著低于试验组(96.15%)(P=0.041)。住ICU时间两组比较差异无统计学意义(P0.05)。结论延长自主呼吸实验时间有助于准确判断老年COPD机械通气患者撤机时机,提高撤机成功率。     

浅快呼吸指数对COPD机械通气病人撤机的意义

目的研究浅快呼吸指数(RSBI,f/Vt)对慢性阻塞性肺病(COPD)机械通气病人撤机的指导意义.方法对符合临床撤机条件的132例COPD机械通气病人,在无任何呼吸支持条件下测定RSBI值,然后进行撤机试验,并对符合撤机条件者进行撤机,观察RSBI值与撤机结果之间的关系.结果撤机成功组80例,RSBI值为64.97±26.84bpm/L;撤机失败组52例,RSBI值为85.67±28.52 bpm/L;撤机失败组的RSBI明显高于成功组(P＜0.05).撤机成功组中,68例RSBI≤105bpm/L,12例＞105bpm/L;失败组中,34例RSBI≤105bpm/L,18例＞105bpm/L;以RSBI≤105bpm/L为标准,其预测撤机成功的灵敏度为85.0%,特异度为34.6%.结论RSBI对COPD机械通气病人的撤机有一定指导意义.     

膈肌超声评估机械通气撤机中临床应用价值

目的探讨超声评估膈肌功能指导呼吸衰竭有创机械通气患者撤机中的临床预测价值。方法选取2020年1月至2022年2月宁波大学附属人民医院收治入院急性呼吸衰竭实施有创机械通气撤机患者53例, 符合撤机条件后使用T管进行自主呼吸实验(SBT), SBT 30 min时应用床旁超声采集患者右侧膈肌移动度(DE)、膈肌厚度, 并计算浅快呼吸指数(RSBI)、膈肌浅快呼吸指数(D-RSBI)及膈肌厚度变化率(DTF), 根据撤机结果将其分为撤机成功组和撤机失败组。收集所有入组患者临床资料, 比较两组患者的超声参数指标、临床指标关系, 采用受试者工作特征曲线(ROC)评价膈肌功能超声指标对预测撤机的临床应用价值。结果 53例患者均纳入分析, 撤机成功组36例, 撤机失败组17例。撤机成功组患者DE、DTF高于撤机失败组(均P<0.05), 撤机成功组RSBI、D-RSBI明显低于撤机失败组(均P<0.05);ROC曲线分析显示当DE、DTF、RSBI、D-RSBI截断值分别>1.21 cm、>27.5%、<48.68次/(min·L)、<1.31次/(min·mm)...     

以护士为主导的早期肺康复治疗在预防呼吸机相关膈肌功能障碍中的效果观察

目的:探讨以护士为主导的早期肺康复治疗在预防呼吸机相关膈肌功能障碍(V IDD)中的应用效果.方法:选取2019年8月—2021年2月某三级甲等医院呼吸重症监护室(RIC U)收治的68例机械通气病人为研究对象,采用随机数字表法分为对照组(33例)和观察组(35例).对照组实施机械通气常规护理,观察组实施以护士为主导的早期肺康复治疗.在干预5 d后比较两组病人VIDD发生率、浅快呼吸指数(RSBI)、氧合指数(OI),比较两组病人呼吸机相关性肺炎(ventilator associated pneumonia,VAP)发生率、撤机成功率、机械通气时间和ICU住院时间.结果:观察组病人VIDD发生率、RSBI较对照组明显下降(P<0.05),两组病人OI比较差异无统计学意义(P>0.05),观察组VAP发生率较对照组明显下降(P<0.05),撤机成功率较对照组明显升高(P<0.05),机械通气时间和ICU住院时间较对照组明显缩短(P<0.05).结论:在符合肺康复指证的情况下以护士为主导的早期肺康复治疗可有效改善机械通气病人的膈肌功能,降低VIDD发生率和RSBI,降低病人VAP发生率和提高病人撤机成功率,缩短病人机械通气的时间和IC U住院时间.     

膈肌增厚分数指导慢性阻塞性肺疾病机械通气患者撤机的临床研究

目的：通过床旁超声评估慢性阻塞性肺疾病机械通气患者的膈肌功能,明确膈肌超声指标对撤机的指导价值。方法研究对象为2015年2月至2015年8月浙江大学附属邵逸夫医院危重医学科诊治的需行有创机械通气的慢性阻塞性肺疾病患者。在患者符合临床撤机筛查条件后进行自主呼吸试验1h。自主呼吸试验结束时采用床旁 B 型超声评估患者膈肌指标,包括吸气末膈肌厚度（ diaphragmatic thickness at the end of inspiration, DTei）、呼气末膈肌厚度（ diaphragmatic thickness at the end of expiration, DTee）、膈肌增厚分数（ diaphragmatic thickening fraction, DTF）,同时记录浅快呼吸指数及其他生理参数。对符合临床撤机标准者进行撤机。统计分析膈肌超声指标与撤机结果之间的关系,采用接受者操作特征曲线（ ROC）分别评价DTF和浅快呼吸指数对撤机成功的预测价值。结果共43例患者纳入本研究,其中撤机成功25例,撤机失败18例。撤机成功组和失败组的撤机前参数如年龄、体质量指数、急性生理学和慢性健康状况评分Ⅱ、机械通气时间、心率、平均动脉压、分钟通气量、氧合指数等差异均无统计学意义（ P＞0.05）。膈肌静态指标DTei、 DTee在撤机成功组和失败组之间差异无统计学意义（ P＞0.05）。撤机成功组撤机前的DTF （39.66±13.22）％vs.（23.84±8.85）％显著高于撤机失败组（P＜0.05）。以DTF≥30％为标准预测撤机成功,敏感度84％,特异度83.33％, ROC曲线下面积0.872（95％ CI：0.759～0.985）。撤机成功组撤机前的浅快呼吸指数（62.74±26.05） vs.（98.89±35.44）显著低于撤机失败组（ P＜0.05）。以浅快呼吸指数≤105为标准预测撤机成功,敏感度92％,特异度38.89％, ROC 曲线下面积0.804（95％ CI：0.669～0.940）。结论膈肌超声指标DTF对慢性阻塞性肺疾病机械通气患者撤机时机选择和撤机结果预测具有指导作用。     

肺部超声对AECOPD机械通气患者有效撤机的临床价值研究

目的 探究基于肺部超声对慢性阻塞性肺病急性加重（AECOPD）机械通气患者有效撤机的临床价值。方法选取AECOPD并发呼吸衰竭予以机械通气患者83例,根据是否撤机成功分为成功组和失败组。分析影响患者撤机成功的影响因素,包括急性生理与慢性健康评分（APACHEⅡ）评分、机械通气时间、肺部超声评分（LUBS）、临床肺部感染评分（CPIS）、胸腔积液量、浅快呼吸指数（RSBI）、膈肌活动度（DE）、膈肌厚度及膈肌增厚率（DTF）。采用受试者工作特征（ROC）曲线分别评价超声相关指标对撤机成功的预测价值。结果 撤机成功51例,失败32例。成功组患者的APACHEⅡ评分高于对照组,机械通气时间短于失败组,差异均有统计学意义（t分别=-2.12、3.18,P均<0.05）;成功组患者的LUBS、CPIS、胸腔积液量、RSBI指标均明显低于失败组,差异均有统计学意义（t分别=8.26、6.71、3.96、4.59,P均<0.05）;成功组DE、吸气末膈肌厚度（DTei）、呼气末膈肌厚度（DTee）、DTF明显高于失败组,差异均有统计学意义（t分别=-6.50、-9.76、-7.43、-4...     

慢性阻塞性肺疾病患者程序化撤机策略的研究

目的探讨慢性阻塞性肺疾病（COPD）程序化撤机策略。方法采用前瞻组性对照研究方法。将COPD机械通气患者分为两组,程序化组采用程序化撤机策略,患者先通过浅快呼吸指数筛选,随即进行自主呼吸试验（SBT）,通过SBT患者即可拔除气管插管。非程序化组患者依靠医生的主观判断与临床经验来决定撤离呼吸机的时机。结果程序化组与非程序化组机械通气时间分别为（8．01±7．22）d和（10．74±5．58）d,ICU住院时间分别为（8．86±6．92）d和（12±6．10）d,程序化组明显低于非程序化组（P〈0．05）。程序化组撤机成功率为76．31％,非程序化组为47．36％,差异有统计学意义（P〈0．05）。结论应用程序化撤机策略及SBT方法可以减少COPD患者机械通气时间及住ICU时间,提高撤机的成功率。     

纤维支气管镜在慢性阻塞性肺疾病机械通气序贯撤机中的应用

目的 观察应用纤维支气管镜(纤支镜)辅助慢性阻塞性肺疾病急性发作(AECOPD)并发呼吸衰竭患者机械通气时序贯撤机的临床疗效.方法 将106例AECOPD并发呼吸衰竭接受经口气管插管和机械通气者随机分为2组:应用纤支镜辅助有创-无创机械通气序贯撤机组(A组,54例)和有创-无创机械通气序贯撤机组(B组,52例).A组纤支镜从气管导管外进入气道,操作过程中不间断使用呼吸机.两组患者一般治疗相同,达肺部感染控制窗( PIC)后拔除气管导管改无创机械通气模式,然后依情况决定撤机.治疗后比较两组病例下列指标:(1)PIC出现时间、总机械通气时间、住ICU时间、首次撤机成功率、再上机率、呼吸机相关肺炎(VAP)发生率;(2)纤支镜操作对该类患者的安全性.结果 A组和B组PIC出现时间分别为(5.01±1.49)d、(5.87±1.87)d,p＜0.05;总机械通气时间分别为(6.98±1.84)d、(8.69±2.41)d,P＜0.01;住ICU时间分别为(9.25±1.84)d、(11.10±2.63)d,P＜0.01;首次撤机成功率分别为96.30％、76.92％,P＜0.01;再上机率分别为5.56％、19.23％,P＜0.05;VAP发生率分别为3.70％、23.07％,P＜0.01.治疗组纤支镜操作简便、安全,未发生明显不良反应.结论 AECOPD并发呼吸衰竭进行机械通气患者应用纤支镜辅助治疗可缩短机械通气时间,增加撤机成功率,减少VAP的发生,且方便安全.     

浅快呼吸指数在慢性阻塞性肺疾病合并呼吸衰竭患者呼吸机撤离中的应用评价（附81例分析）

目的 评价浅快呼吸指数(f/VT)在慢性阻塞性肺疾病(COPD)并呼吸衰竭的机械通气患者脱机时的指导意义.方法 81例COPD并呼吸衰竭机械通气患者达到临床撤机标准后,监测其浅快呼吸指数(f/VT).结果 撤机成功组(64例)f/VT平均为80±21,撤机失败组(17例)f/VT平均为110±20,撤机成功组f/VT明显低于撤机失败组(P<0.05).撤机成功组中f/VT≤105者60例,f/VT>105者4例;撤机失败组中f/VT≤105者8例,f/VT>105者9例,以f/VT≤105为标准,其预测撤机成功的灵敏度为93.8%,特异度为52.9%.结论 f/VT对COPD并呼吸衰竭患者呼吸机撤离有一定的指导意义,是较好的预测脱机的指标之一.     

70岁以上老年人慢性阻塞性肺疾病有创机械通气撤机时机分析

目的 探讨老年人慢性阻塞性肺疾病(COPD)有创机械通气的撤机时机.方法 对照组采用SIMV+ PSV方式撤机,试验组寻找肺部感染控制窗+自主呼吸试验(2 h)+无创通气的方法撤机,观察两组有创机械通气时间、VAP发生率、住院时间、再插管率及病死率等.结果 试验组的各项观察指标都明显低于对照组,差异有统计学意义(P＜0.05).结论 试验组达到了缩短有创机械通气时间,降低VAP发生率、再插管率、住院时间及死亡率的目的.     

Transitional Percentage of Minute Volume as a Novel Predictor of Weaning from Mechanical Ventilation in Patients with Chronic Respiratory Failure

PurposeSome patients with respiratory failure fail initial weaning attempts and need prolonged mechanical ventilation (MV). Prolonged MV is associated with many complications and consumption of heathcare resources. Objective weaning indices help staffs to identify high-potential patients for weaning from the MV. Traditional weaning indices are not reliable in clinical practice. Transitional percentage of minute volume (TMV%) is a new index of the work of breathing. This study aimed to investigate the utility of TMV% in the prediction of weaning potential.MethodsThis study was prospectively performed including all patients with prolonged MV. Researchers recorded their demographics, TMV%, respiratory parameters, Acute Physiology and Chronic Health Evaluation II score, and laboratory data upon arrival at the respiratory care center. The factors associated with successful weaning were analyzed.ResultsOut of the 120 patients included, 84 (70.0%) were successfully weaned from MV. Traditional weaning indices such as rapid shallow breathing index could not predict the weaning outcome. TMV% was a valuable parameter as patients with a lower TMV%, higher tidal volume, higher hemoglobin, lower blood urea nitrogen, and lower Acute Physiology and Chronic Health Evaluation II scores had a higher rate of successful weaning. TMV%, tidal volume, and HCO3^- levels were independent predictors of successful weaning, and the area under the curve was .79 in the logistic regression model.ConclusionTMV% is a novel and effective predictor of successful weaning. Patients with lower TMV% had a higher MV weaning outcome. Once patients with a high potential for successful weaning are identified, they should be aggressively weaned from MV as soon as possible.Clinical Trials Government IdentifierNCT033480.     

长期机械通气老年患者撤机的影响因素分析

目的探讨长期机械通气的老年患者撤机的影响因素。方法回顾性分析2006年1月至2010年6月内科重症监护病房（MICU）收治的136例长期机械通气的老年患者。根据撤机成败判定标准将全部病例分为撤机成功组（72例）和撤机失败组（64例）,比较两组患者机械通气时间、年龄、住院时间、气管切开例数、基础疾病和入科第1天及第10天的急性病生理学和长期健康评价（APACHE）Ⅲ评分及各项生理指标,采用logistic回归分析法对各指标进行分析,并运用受试者工作特征（ROC）曲线对第10天的APACHEm评分及血乳酸水平预测长期机械通气的老年患者撤机成功与否作评价。结果两组患者住院时间比较差异有统计学意义（P〈0．05）,撤机成功组患者第1天仅APACHEⅢ评分、白蛋白水平优于撤机失败组（P均〈0．05）;第10天APACHEⅢ评分、氧合指数、平均动脉压、肺泡一动脉血氧分压差、血乳酸、白细胞、血小板、总胆红素、丙氨酸转氨酶、肌酐、白蛋白、血糖、血钠水平均优于撤机失败组（P均〈0．05）。logistic分析示第10天APACHEm评分〉60分、第10天血乳酸〉2．0mmol／L是影响撤机成功与否的独立危险因素,其ROC曲线下面积分别为0．894（95％可信区间：0．836～0．951）、0．738（95％可信区间：0．648～0．828）。结论APACHEm评分、血乳酸水平对预测长期机械通气患者能否成功撤机有一定影响。     

自主呼吸试验在撤机中的应用

目的 对应用自主呼吸试验(SBT)撤机方式与逐渐降低机械通气支持水平撤机方式成功拔管的患者进行比较,以寻找最佳撤机方式.方法 选择57例机械通气患者,病情稳定后通过撤机试验前评估,然后准备撤机.采用前后对照的方法将患者分为两组,2004年6月-2005年12月的21例患者作为对照组,采用逐渐降低机械通气支持水平的撤机方式拔管;2006年1月-2007年3月的36例患者作用为试验组,采用SBT的撤机方式拔管.分别观察两组患者的机械通气时间、住重症监护病房(ICU)时间、呼吸机相关性肺炎(VAP)发生率、48 h内再插管率、ICU病死率.结果 试验组与对照组的机械通气时间分别为(59.45±37.1)h和(111.4±59.8)h(P=0.001),住ICU时间分别为(8.0±5.5)d和(15.3±14.3)d(P=0.034),VAP发生率分别为16.7%和38.0%(P=0.070),48 h内再插管率分别为19.4%和5.0%(P=0.253),ICU病死率分别为25.0%和24.0%(P=0.920).结论 SBT的撤机方式比逐渐降低机械通气支持水平的撤机方式具有机械通气时间和住ICU时间短的优点,而两组VAP发生率、48 h内再插管率、ICU病死率基本相同.     

Breathing pattern variability: a weaning predictor in postoperative patients recovering from systemic inflammatory response syndrome

Objective To investigate whether breathing pattern variability can serve as a potential weaning predictor for postoperative patients recovering from systemic inflammatory response syndrome (SIRS).Design and setting A prospective measurement of retrospectively analyzed breathing pattern variability in a surgical intensive care unit.Patients Seventy-eight mechanically ventilated SIRS patients who had undergone abdominal surgery were included when they were ready for weaning. They were divided into success (n=57) and failure (n=21) groups based upon their weaning outcome.Measurements and results Before weaning, tidal volume, total breath duration, inspiratory time, expiratory time, and peak inspiratory flow were continuously monitored for 30 min, while patients received 5 cmH₂O pressure support weaning trial. After the patients successfully completed the trial, they were extubated. Successful weaning was defined as patients free from the ventilator for over 48 h, whereas a weaning failure was considered as reinstitution of mechanical ventilation within 48 h of extubation. The coefficient of variation and two values of standard deviation (SD₁ and SD₂; indicators of the dispersion of data points in the plot) obtained from the Poincaré plot of five respiratory parameters in the failure group were significantly lower than those in the success group. The area under the receiver operating characteristic curve of these variability indices was within the range of 0.73–0.80, indicating the accuracy of prediction.Conclusions Small breathing pattern variability is associated with a high incidence of weaning failure in postoperative patients recovering from SIRS, and this variability may potentially serve as a weaning predictor.Electronic Supplementary Material Supplementary Material is available in the online version of this article at Supported by grants NSC91-2320-B-010-046-M59 and NSC91-2314-B-075-067 from the National Science Council, Taiwan, grant VGH-91-095 from Taipei Veterans General Hospital, Taiwan, and grant VTY92-P5-30     

相对性肾上腺皮质功能不全与呼吸机撤离的关系及对预后的影响

目的对机械通气的重症患者进行肾上腺皮质功能状态分析,探讨相对性肾上腺皮质不全(RAI)与呼吸机撤离的关系,评价肾上腺皮质功能测定对呼吸机撤离及预后的意义。方法选择上海仁济医院急诊科及急诊ICU机械通气超过24 h的患者,使用250μg促肾上腺皮质激素(ACTH)静脉注射,测定刺激前及刺激后60 min血浆总皮质醇水平,即T60与T0,二者的差值ΔT≤9μg/dl定义为RAI。分析RAI与呼吸机撤离的相关性,使用Kaplan-Meier评价RAI与机械通气患者30 d存活率的相关性。结果共60例机械通气患者纳入研究,其中有创通气38例,无创通气22例;撤机成功24例,撤机失败36例。卡方检验显示,成功撤机组RAI患者比例明显著低于非RAI患者(P=0.000 11),并在有创通气组中更为明显。同时机械通气患者30 d存活率观察发现,合并RAI的患者死亡率明显高于非RAI通气患者(P=0.000 3)。结论 RAI明显影响有创通气的撤机成功率,并与机械通气的死亡率显著相关。     

机械通气患者的脱机（附85例分析）

分析了８５例机械通气患者恢复时的脱机过程。列举２例脱机困难者的处理。讨论了脱机患者的病理生理改变，脱机标准的掌握和营养支持与脱机的关系。认为脱机时机的掌握，脱机过程的调节，以及必要的营养支持有益于顺利脱机。     

超声量化膈肌收缩速度在判断机械通气撤机中的价值

目的:探讨超声检测膈肌收缩速度判断机械通气患者撤机成功的价值。方法:2016年7月至2019年2月,以复旦大学附属中山医院急诊ICU的94例有创机械通气的患者为研究对象,其中急性呼吸窘迫综合征患者61例,心肺复苏术后患者33例。94例患者分为撤机成功组(n=73)和撤机失败组(n=21)。自主呼吸试验第0 min、5 min、30 min用超声检查膈肌,根据膈肌位移和吸气时间计算膈肌收缩速度。用ROC曲线法通过膈肌收缩速度预测撤机成功的价值。结果:撤机失败组膈肌功能障碍19例,占90.48%,撤机成功组膈肌功能障碍41例,占56.16%,组间差异有统计学意义(P0.05)。随着自主呼吸试验时间延长,撤机成功组和撤机失败组的膈肌收缩速度均有所升高(P0.05)。撤机成功组在自主呼吸第5 min和30 min时膈肌收缩速度均低于撤机失败组,组间差异有统计学意义(P0.05)。自主呼吸第0 min和5 min时,膈肌收缩速度预测撤机成功的AUC分别为0.469和0.501。第30 min时预测价值最高,AUC为0.791,灵敏度和特异度分别达75.32%、69.37%(P0.05)。结论:采用超声检测膈肌功能较为简便,自主呼吸试验第30 min时,以膈肌收缩速度≤1.57 cm/s为临界值时预测撤机成功的价值较高。     

Protocolized weaning from mechanical ventilation: ICU physicians' views

BACKGROUND: The use of protocols during weaning from mechanical ventilation is uncommon in the UK, despite research pointing to their potential benefits. This may be because the research evidence is considered not to apply in different settings. Intensive care unit consultant physicians are the major decision-makers in weaning in the UK and any attempt to introduce protocolized weaning will require consideration of their views. AIM: The aim of this paper is to report a study exploring intensive care physicians' views on (i) weaning from mechanical ventilation, (ii) the utility of weaning protocols and (iii) nurses' roles in the weaning process. A specific goal was to identify potential aids and barriers to developing weaning protocols and their introduction into clinical practice. METHODS: Qualitative interviews were conducted with a purposive sample of 10 consultant physicians in two intensive care units in Northern Ireland and subjected to content analysis. FINDINGS: The primary themes identified were (i) information required for weaning decisions and clinical judgement, (ii) professional boundaries, (iii) protocol issues and (iv) timing of weaning. Three types of information were deemed to be required for weaning decisions - empirical objective, empirical subjective and abstract - and interviewees considered that it would be challenging to incorporate all into a protocol. They were divided on whether protocols were useful when nursing experience was limited. Some groups of patients were thought more suitable than others for protocolized weaning. CONCLUSIONS: Although local physicians were supportive in theory, introduction of protocolized weaning is likely to be difficult because of the breadth of information required for successful decision-making. Consultant views in this study were not consistent with American findings that physicians' caution may unnecessarily prolong weaning.     

Successful weaning and decannulation after interventional bronchoscopic recanalization of tracheal stenosis

Purpose

Early posttracheostomy tracheal stenosis (PTTS) may cause weaning and decannulation failure. Although bronchoscopic recanalization offers an effective treatment, it is not known how successfully patients can be weaned and decannulated after recanalization. The aims of this study were to determine the incidence of PTTS in a modern weaning center and to elucidate the benefit of interventional recanalization in terms of weaning and decannulation success.

Materials and methods

A total of 722 patients admitted within a 24-month period were examined. Patients' baseline characteristics, incidence of weaning and decannulation failure, incidence of PTTS, and rate of postinterventional weaning and decannulation success were determined.

Results

Of 722 patients, 450 were deemed suitable for weaning from invasive ventilation. Two hundred eighty-eight patients showed initial weaning and decannulation failure, and 14 of these 288 patients (4.9%) were found to have a PTTS. Recanalization was performed in all cases without procedure-associated complications. Ten (71%) of 14 patients could be successfully weaned and decannulated. Seven of these 10 patients were discharged, 3 patients died during the hospital stay, and 4 (29%) of 14 patients could not be weaned.

Conclusions

Posttracheostomy tracheal stenosis remains a relevant cause of weaning and decannulation failure. Bronchoscopic recanalization is safe and facilitates weaning and successful decannulation in about half of the cases.     

Issues in weaning from mechanical ventilation: literature review

AIM: The aim of this paper is to raise questions on the effect of skill mix and organizational structure on weaning from mechanical ventilation. BACKGROUND: Mechanical ventilation is an essential life-saving technology. There are, however, numerous associated complications that influence the morbidity and mortality of patients receiving intensive care. Therefore, it was essential to use the safest and most effective form of ventilation for the shortest possible duration. Because of the potential complications and costs of mechanical ventilation, research to date have focused on accurate weaning readiness assessment, methods and organizational aspects that influence the weaning process. METHOD: In early 2005, the literature was reviewed from 1986 to 2004 by accessing the following databases: Medline, Proquest, Science Direct, CINAHL, and Blackwell Science. The keywords mechanical ventilation, weaning, protocols, critical care, nursing role, decision-making and weaning readiness were used separately and combinations. DISCUSSION: Controversy exists in weaning practices about appropriate and efficacious weaning readiness assessment indicators, the best method of weaning and the use of weaning protocols. Arguably, the implementation of weaning protocols may have little effect in an environment that favours collaboration between nursing and medical staff, autonomous nursing decision-making in relation to weaning practices, and high numbers of nurses qualified at postgraduate level. CONCLUSION: Further research is required that better quantifies critical care nurses' role in weaning practices and the contextual issues that influence both the nursing role and the process of weaning from mechanical ventilation.