Table 1.

Factors to consider before deciding to Wean off Mechanical Ventilation

• Respiratory function (efficacy, efficiency, strength and endurance) • Nature of respiratory failure/insufficiency • Respiratory function while awake vs. asleep • Restrictive respiratory mechanics from long-standing myopathic changes that warrant ongoing supports (e.g., scoliosis) • Secretion management (i.e., oro- and nasopharyngeal as well as tracheal) • Swallow studies • Tolerance of intercurrent respiratory tract infection without needing ventilator support • Health-related quality of life • Chronic lung disease or comorbidities independent of respiratory muscle function

• Cardiopulmonary interactions (i.e., rule-out primary or secondary pulmonary hypertension) • Upper airway assessment (i.e., enlarged tonsils/adenoids, laryngeal and/or tracheomalacia) • Tracheobronchial assessment (i.e., mucosal integrity, laryngeal clefts, tracheomalacia, granulomas, or stenosis) • Nutrition and metabolic demands • Developmental status • Tolerance of interventions (invasive or noninvasive) or need for other adjuvants • Environmental factors (i.e., caution weaning during high-infection seasons) • Immunization status (i.e., fully immunized) • Planned surgeries in the near future