1999 Donald F Egan Scientific Lecture. Weaning from mechanical ventilation: what have we learned?

It is a pleasure and honor for me to give the 26th Annual Donald F Egan Scientific Lecture at the American Association for Respiratory Care. Much of my research career has focused on weaning from mechanical ventilation, and a major stimulus for my interest in this subject was an outstanding review article published in RESPIRATORY CARE by its current editor, Dave Pierson, in the early 1980s.1 In that article, Dave made the subject of weaning exciting. More importantly, he pointed out many areas about which we knew nothing. To someone starting an academic career, the subject of weaning appeared particularly ripe for research. While preparing for this morning’s lecture, I took my copy of Egan’s Fundamentals of Respiratory Therapy from the shelf. This was the first textbook directed primarily at respiratory therapists. It was first published in 1969, and the copy I own is the third edition, published in 1977.2 In the 1977 edition, Dr Egan wrote that “The separation of a patient from his ventilator is very nearly pure art.” Weaning is still an art in 1999. But over the next half hour, I hope I can show you that the approach to weaning has a more scientific basis than was the case 20 years ago.