“Weaning from the vent” means
reducing a patient’s usage of the vent to the point the patient is
able to breathe again normally on their own, unassisted.
“Extubation” means disconnection and removal of the
mechanical vent tube from the patient’s mouth and throat or
The ARDS Support Center received an inquiry
about the process of weaning the patient from the Ventilator. The
following comments were provided by Max Eskelson who is a member of
ASC Board of Medical and Professional
First, allow me to introduce myself - my name is Max Eskelson, and
I am a Respiratory Therapist at the LDS Hospital in Salt Lake City,
How long does it take to wean a patient from
the Ventilator? The answer is,"It Depends." There are so
many variables that come into play that it cannot be said with any
certainty how long the course might be. Some of the variables include
the initial disease process, the previous health of the patient, and
the physical state of the patient When someone makes a prediction,
they are only quoting statistics. They are talking about the average.
Because they are talking about the average, it stands to reason that
some will recover more quickly, and some will take longer.
Over the years, it has become obvious that
physical therapy is paramount to lung recovery. The therapy may
include dangling on the side of the bed, standing, walking short
distances (and increasing the distance over time) a bed bike, and so
on. Another key ingredient is nutrition. The patient cannot exercise
and regain muscle strength without adequate nutrition. As to coughing,
the patient has a tube going down his throat, and this is not
comfortable (at best). It is irritating, and the mouth cannot be
closed. This feels strange. Secretions often do not play a role with
coughing. We see patients all the time with terrible coughs, yet have
no secretion production.
Sedation during the process may not be a good idea. This is because
it is desireable that the patient actively participate in the various
therapies that will allow extubation (tube removal). There is a fine
line that is walked between not allowing the patient to experience
pain, and allowing them to participate in their care.
The basics for weaning from the ventilator,
and eventual extubation (they are two separate and distinct actions)
1) taking care of the underlying process;
2) physical therapy
3) nutrition, and
4) trials of spontaneous breathing.
Max Eskelson RRT, BSBA
The following was contributed by Mark Lowery,
formerly associated with the ARDS Support Center.
Concerning weaning from the vent, the process involves a gradual
lessening of the reliance upon the vent (oxygen level and pressure),
with short and then increasing periods of stopping usage of the vent
to force and allow the lungs to breathe on their own, ultimately to a
point where the vent is simply removed (extubation). If a trachesotomy
has been performed, this may also be a factor in the processes. The
weaning process has been the subject of medical research and articles,
all of which fairly indicate that each case is unique.
A comparison between how individuals
handle the process is difficult to make.
.In some cases the patient may seem to become
mentally reliant upon the vent and fearful that if it is removed they
will no longer be able to breath. Anti-anxiety drugs may be used to
counter this fear. It may take several attempts to wean, and this is
neither unheard of or necessarily abnormal. It may help to explain the
weaning process to the patient. Reassurance and calming influences
such as reading, prayer, soothing music or gentle massages may help
the patient become more at ease during the weaning process. Such
efforts should be done only with the permission and supervision of the