Comparison of Standard Weaning Parameters and the Mechanical Work of Breathing in Mechanically Ventilated Patients

Comment As one develops more sophisticated and cumbersome tests, it behooves the investigators to prove their ability to predict. This report documents that mechanical work of breathing correlates with chronic ventilator patients' successful weaning. However, all weaning was done independent of the findings. Did the test add knowledge to those physicians taking care of patients in making decisions? No. The authors must now document, prospectively, that using the test of mechanical work of breathing, they can predict successful weaning. The authors criticize the older, tried and tested methods of predicting ability to wean, but the maximum inspiratory force and the vital capacity were not followed as trends—only as one-time measurements. Regardless of the age of the test, old or new, the clinician must weigh many factors in progressing toward weaning. The short-term ventilator patient weaning from mechanical breathing is easy and can be set up in an algorithm. The chronic ventilator-dependent patient is much harder to wean. It requires not only the science of analyzing test data, but it also requires clinical acumen. It requires the art of medicine. Let us not forget to become involved with the total patient—not just numerical values. William D. Owens, M.D.