Until approximately 8 years ago, weaning patients from mechanical ventilatory support was as much of an art as a science. Since then, large, randomized, multi-institutional studies have provided evidence that weaning time is prolonged when intermittent mandatory ventilation is used as the weaning mode6–7 and that a 30-min trial of spontaneous breathing is as effective as 2-h trial to determine whether weaning will be successful.8 However, these studies included patients with varying diagnoses. The article by Vitacca and coworkers focused on 52 patients who required mechanical ventilation because of an acute exacerbation of COPD. Half of these patients were weaned using continuous positive airway pressure (CPAP) from an initial PS setting of approximately 19 cm H2O in 2-cm increments twice daily until they tolerated CPAP with a PS of 8 cm for 8 h. The remaining 26 patients were weaned by spontaneous breathing trials via a T-piece performed twice daily. Both groups achieved equal rates of weaning success (73% vs 77%, respectively), duration of ventilatory support (181 vs 130 h, respectively), and ICU lengths of stay. Therefore, in this select group of COPD patients, neither method appeared to be superior or inferior. The authors also compared the study patients (combined data) to 55 patients who were being managed without a formal protocol. In this comparison, the study patients whose conditions had been managed via a protocol were successfully weaned more frequently (87% vs 70%, respectively), and experienced shorter durations of mechanical ventilation and shorter stays in the ICU (27 vs 38 days, respectively) than the group of patients whose conditions had been managed without a protocol. Therefore, although there was no difference in weaning patients with COPD using CPAP and PS vs T-piece trials, there were significant benefits when a set protocol was utilized.