Respiratory controversies in the critical care setting. Should weaning protocols be used with all patients who receive mechanical ventilation?

Ventilator weaning protocols have the potential to expedite the weaning process and have been shown to reduce weaning time and the duration of mechanical ventilation in several studies. However, other studies have found no benefits from weaning protocols, and they may be particularly superfluous in highly staffed and structured intensive care units. Furthermore, for a protocol to improve outcomes, the clinicians must have a high rate of adherence to the protocol. Weaning protocols might improve patient care and outcomes, but their implementation should be based on local clinical characteristics and needs, and accompanied by an intensive education effort and measurement of adherence and outcomes.