الفهرس 
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Abstract
Weaning from mechanical ventilation is an essential element in the care of critically ill patients receiving mechanical ventilation. Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube, including relevant aspects of terminal care (1). Time spent in the weaning process represents 40-50% of the total duration of mechanical ventilation (2–4). Mortality increases with increasing duration of mechanical ventilation, in part because of complications of prolonged mechanical ventilation, especially ventilator-associated pneumonia and airway trauma (5). Difficult weaning includes patients who require up to three Spontaneous Breathing Trial (SBT) or as long as 7 days from the first SBT to achieve successful weaning. Prolonged weaning includes patients who require more than three SBT or 7 days of weaning after the first SBT.
There is still uncertainty about the best methods for weaning from mechanical ventilation (2–6). In recent years, development of numerous modes of mechanical ventilation, which could support spontaneous breathing, has made it possible to gradually decrease the mechanical ventilatory support (12–15). New modes which depend on Closed-loop ventilation, are variable. However, there is still insufficient evidence to support use of any of these new modes in weaning (16). Automated weaning with closed loop weaning is still under big debate of cost-benefit and effectiveness. In our study, we compared two advanced, but relatively common and cheap, modes of mechanical ventilation with the most widely used weaning mode, Pressure Support Ventilation.
The aim of this work was to compare between three different modes of mechanical ventilation: Pressure Support Ventilation (PSV) versus Volume Support Ventilation (VSV) versus Mandatory Minute Ventilation (MMV) as weaning modes in “difficult weaning” patients. The primary outcome was “Rate of successful weaning”. Secondary outcomes were Total weaning Time (TWT), total Time of mechanical ventilation (TMVT), need for non-invasive ventilation after extubation, and need for sedation.