As a critical care nurse for 22 years I commend you for addressing the psychological aspects of weaning patients off the ventilator in the intensive care unit (ICU) in your July, 2011 article by Chen et al.

It has been my experience that the focus of the weaning process has had more emphasis on the dynamics of ventilation and perfusion, and not the psychosocial components. One of the stressors of the ICU nurse is to ensure that patients are safe from self-extubating. An important aspect of delirium that needs more investigation is the undetected alcohol withdrawal patient, since this can make weaning from the ventilator more difficult.

A history of alcohol intake might prove difficult since many patients admitted to the ICU are too sick to provide a history, or many times patients and families do not consider the daily use of...

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