Mechanical ventilator liberation protocol. Recommendation based on review of the evidence

Mechanical ventilation is currently the most widely used supportive therapy for the treatment of moderate and severe hypoxemia of any etiology. However, the decision of "when" is the right time to initiate the withdrawal of this support is currently a matter of debate worldwide. Many authors describe that the disconnection process should be gradual and in compliance with standards that provide safety to this process; while other authors report that it is not feasible to establish a universal standard since each patient would have a unique behavior that would be difficult to establish in a protocolized manner. The present review represents an extensive search for evidence in an attempt to clarify this issue, generating evidence from a consensus of experts at international level, based on a broad review of the literature. Keywords: Weaning, Spontaneous breathing trial, Rapid shallow breathing index, P0.1