Organization of a weaning Unit

Weaning from mechanical ventilation (MV) is an essential and universal element in the care of critically ill patients receiving MV for a prolonged time to restore unassisted breathing. There is much evidence that weaning tends to be delayed, exposing the patient to unnecessary discomfort, increased risk of complications, and increased cost of care. In the past 15 years, availability of beds in intensive care units (ICUs) and new technologies, such as noninvasive mechanical ventilation, coupled with improved levels of care, have highlighted a new population of patients labeled as survivors of a catastrophic illness. Although this group of patients represents less than 10 % of all ICU admissions, they account for a disproportionate burden on health-care financial resources. In most studies, weaning failure occurs when a spontaneous breathing trial (SBT) fails and reintubation is needed [1]. Failure of an SBT is defined by (1) objective indices of failure, such as tachypnea, tachycardia, ypertension, hypotension, hypoxemia or acidosis, and arrhythmia, and (2) subjective indices, such as agitation or distress, depressed mental status, diaphoresis, and evidence of increasing effort. Several studies have proposed the use of noninvasive ventilation (NIV) for extubated patients in different clinical situations, including prophylactic intervention in patients with chronic obstructive pulmonary disease who failed SBT [2], patients with repeated SBT failure [3], and postsurgical patients.