The traditional approach to weaning has been a gradual reduction of ventilatory support—starting with cutting back on supplemental oxygen and eventually ending with extubation or tracheal decanulation—under the direction of a physician. In recent years, however, a protocol-specific approach, implemented by nurses and respiratory therapists, has emerged as a common and effective alternative. Several randomized, controlled trials have found that protocols are more likely to reduce the duration of MV, and the rate of reintubation and VAP, than physician-directed weaning models.2-4 At our large hospital, respiratory therapists (RTs) handle weaning in collaboration with nurses, who perform the bulk of the patient assessment; you may play an even greater role on your unit.