Weaning RC 270

When is the time to consider weaning from the ventilator? When the decision is made to ventilate the patient!

Weaning will be successful only if a potentially reversible disease process exits. Barry Shapiro M.D.

Weaning: Physical Assessment Stable ABGs on 50% or < PNP (NIF) = -20 cmH2O or more – Is not effort dependent VC = 15 ml/kg FEV1 = 10 ml/kg Spontaneous Ve = 5 – 10 lpm MVV = twice the spontaneous Ve P0.1 = 4-6 cmH2O RSBI [f/Vt (in liters)] < 105

Weaning: Gas Exchange Assessments Vd/Vt no greater than 55-60% A-aO2 on 100% no more than 300-350 mmhg %Shunt under 20% P/F = 286 or > PaO2/FIO2 FIO2 expressed as a decimal 200 or less = severe shunting

Weaning: Other Factors to Optimize Acid-Base abnormalities Anemia Arrhythmias Electrolyte imbalance Energy/Nutritional status Fever/Infection Fluid Balance Pain Sleep deprivation

Classical Weaning Spontaneous Breathing Trial If the patient appears ready to wean, he is removed from the Ventilator and placed on a T-tube and monitored

Monitor and place back on CMV if: BP increases/decreases 20 mmhg systolic or 10 mmhg diastolic Heart rate increases/decreases 20 or more (or rate exceeds 110) Respiratory rate increases by 10 or exceeds 30 Vt drops to less than 250-300 ml Arrhythmias develop ABGs deteriorate (may also use pulse oximeter and capnograph)

The time is lengthened each time he is removed from the ventilator

Besides Classical Technique: IMV Pressure Support MMV

The End