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Parameters of failure during a weaning trial

Parameter	Clinical findings
Respiratory	Tachypnea >35 breaths per minute*
Respiratory	Respiratory distress such as use of accessory muscles, thoracoabdominal paradox
Hemodynamic	Heart rate >140 beats/minute or a sustained increase of >20%
	Heart rate <50 beats/minute
	Systolic blood pressure >180 mmHg or <90 mmHg
Gas exchange	Inadequate oxygenation (eg, peripheral saturation <90%, although lower saturations to 88% may be tolerated in chronically hypoxemic patients; arterial oxygen tension <50 mmHg)
Gas exchange	Inadequate ventilation (eg, an increase in PaCO₂ of >10 mmHg from pre-weaning value or a decrease in the pH >0.1 from the pre-weaning value)
Neurologic	Reduced mental status (eg, somnolence, agitation, delirium)
Other	Diaphoresis

These parameters are guides only. Clinicians should use their clinical judgement at the bedside to make a final conclusion regarding success or failure. Nonetheless, in general, the presence of one or more of these generally indicates weaning failure.

PaCO₂: arterial carbon dioxide tension.
* Tachypnea or bradypnea, which is rare unless the patient is over sedated, may also be accompanied by a drop in tidal volume. A cut off tidal volume cannot be made since tidal volume varies with the level of pressure support.

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