Removing the critically ill patient from mechanical ventilation.

Weaning from mechanical ventilation is usually straightforward but is occasionally challenging. Sedation must be used at the appropriate times and with appropriate dosing. A protocol that calls for a daily sedation holiday with a spontaneous breathing trial decreases time on the ventilator. Early tracheostomy is beneficial in traumatic brain injury patients. Noninvasive ventilation is most useful in patients with baseline obstructive sleep apnea and chronic obstructive pulmonary disease.