The methylxanthines, theophylline, and aminophylline, have been used traditionally in patients with airway disease, primarily for their bronchodilating and central nervous stimulatory effects. In the context that these drugs have been shown to favorably affect respiratory muscle contractility and endurance, their use has also been advocated for liberating difficult-to-wean patients from mechanical ventilation and, in our experience, has been used with moderate frequency for this purpose.
This article reviews the in vitro, animal, human, and clinical data regarding use of methylxanthines to facilitate adult patients' liberation from mechanical ventilation. A substantial volume of studies support the favorable effects of methylxanthines on respiratory muscle strength and endurance, including specific benefits in patients with chronic obstructive pulmonary disease, in the postoperative setting, and in settings of respiratory muscle fatigue. Surprisingly, much less attention has been given to using methylxanthines in the specific context of liberating patients from mechanical ventilation, with, to our knowledge, only 2 available case reports.
Overall, available data and experience suggest a role for methylxanthines in facilitating liberation from mechanical ventilation of adult patients, though the paucity of available studies invites further research regarding this specific application.