Theophylline to help wean patients from mechanical ventilation

Few patients require weaning from mechanical ventilation. Theophylline has largely been discarded from day to day pulmonary medicine. Interest in the use of theophylline as a stimulant to help in difficult weaning situations, however, persists. Pathophysiologic rationale, animal studies and low level clinical data indicate that theophylline improves respiratory muscle function. High level clinical studies simply have not been done.

This topic was recently reviewed in Clinical Pulmonary Medicine. The authors of the review were cautiously favorable towards the use of theophylline:

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.

The authors suggest that when used, frequent monitoring of serum levels is advised, aiming for levels slightly below the usual therapeutic range.