Weaning from mechanical ventilation is a multifactorial process. Presence of optimal inspiratory effort after recovery from Neuromuscular blocking agent  (NMBA) is necessary for initiation of weaning . NMBA is used for intubation , preventing
patient – ventilator asynchrony, ARDS or management of raised ICP .

NMBA administration leads to loss of spontaneous inspiratory efforts due to blocking of transmission at neuro-muscular junction, causing paralysis of skeletal muscles. Metabolism and excretion of NMBA  results in recovery from  NMBA effect which leads  to  initiation of spontaneous  inspiratory efforts.

 Time taken for recovery of  inspiratory effort  from NMBA is rarely monitored  in citically ill patients .

Recovery of inspiratory efforts from NMBA can be measured by TOF (train of four) , esophageal pressure  , electrical activity of the diaphragm , performing diaphragmatic ultrasound and P0.1 . Among all the parameters , P0.1 is non invasive , objective and can be measured easily on ventilator .P 0.1  correlates strongly with inspiratory efforts3.

         P 0.1 is the drop in airway pressure (Paw) 100 milliseconds after the onset of inspiration during an end-expiratory occlusion of the airway.

There are no studies regarding the time required to achieve initiation of  inspiratory  effort after administration of neuro-muscular blocking agent( NMBA)  in critically ill patients. The initiation of inspiratory effort translates into optimal inspiratory efforts which in turn leads to initiation of  spontaneous breathing mode.

 This study will record the time duration  between administration of NMBA and  onset of recovery of inspiratory efforts on controlled mode .

The time between onset of optimal inspiratory effort on controlled mode to initiation of spontaneous beathing mode. Risk factors associated with recovery of inspiratory efforts will also  be recorded  .

Insights after analysis can help in formulating pathways for personalised weaning in ICU patients .