Background
Weaning protocols have shortened the duration of mechanical ventilation for many patientsHowever, there are several impediments which delay extubation such asPersistence of the underlying disorderHypoxiaRespiratory muscle weaknessInability to protect the airwayRespiratory secretions may impede weaning through several such mechanisms. They mayLead to pluggingInterfere with gas exchangePromote atelectasisMany diseases in the ICU (e.g., pneumonia, COPD, aspiration) are associated with excess secretions Many patients have a depressed mental status and lung disease which may interfere with their ability to handle secretions