Optimal nutritional support is key to liberation from mechanical ventilation.

Liberation from mechanical ventilation is a physiologically demanding phase of critical illness that requires coordinated recovery of respiratory muscle function, metabolic stability, and systemic resilience. Nutritional therapy plays a central role in supporting this transition. However, early aggressive caloric and protein delivery has not improved outcomes and may be detrimental. Current evidence supports a phase-adapted, individualized approach: permissive underfeeding during acute inflammation, moderate protein provision, monitoring of metabolic tolerance, and targeted correction of micronutrient deficiencies. Future research should incorporate time to successful weaning as a clinically meaningful endpoint when evaluating nutritional interventions in the intensive care unit.