Weaning from Mechanical Ventilation

Flashcards about weaning from mechanical ventilation

What might some patients require for weaning?

Some patients need a slower weaning process, needing ventilatory support, oxygen and PEEP, or just an artificial airway.

What does SIMV involve, and what is the weaning strategy?

SIMV involves synchronized IMV breaths, with a strategy of progressively reducing mandatory breaths as tolerated and may use pressure support.

How can SIMV negatively impact weaning?

SIMV can increase work of breathing due to respiratory dyssynchrony and prolong weaning.

How does PSV work and how is weaning accomplished?

In PSV, the patient controls rate, timing, and depth. Weaning involves decreasing the PS level gradually to overcome ET resistance.

What is involved in T-piece trials and what equipment is used?

T-piece trials involve removing the ventilator, starting with short periods and gradually increasing as tolerated, using a Briggs-Adapter with aerosol tubing.

What monitoring and safety measures are important during T-piece weaning?

Patient is closely monitored during T-piece weaning, with the possibility of deflating the OETT cuff and elevating the HOB to guard against aspiration.

Which method has the potential to cause the greatest work of breathing?

SIMV has been shown to take the longest and potentially cause the greatest work of breathing for the patient, so another mode should be selected if the current one doesn’t work.

What three points must be addressed before weaning?

• pathology reversal

• acceptable weaning criteria

• successful SBT

Describe the ideal state of patients considered for weaning

Weaning candidates should be on no sedation and minimal analgesics, with adequate cough/gag reflex and cuff leak.

What are the adequate oxygenation requirements for weaning?

Adequate oxygenation for weaning includes PaO2 > 60 on FIO2 < 0.4, PaO2/FIO2 > 150-200, and PEEP < 5-8.

What are the typical weaning parameters?

• f < 35

• VT 4-6 ml/kg

• VE 10-15 L/min

• RSBI < 105

• NIF -20 to -30

• VC > 15 ml/kg

Define RSBI, NIF and VC

RSBI (f/VT) indicates ventilatory performance and predicts fatigue. NIF (MIP) demonstrates muscle strength. VC reflects respiratory muscle strength and ability to cough.

What factors should be considered during weaning parameter measurements?

• Important to consider during weaning parameter measurement are the patient's position,

• OETT size

• secretions present.

What are some physical signs of increased work of breathing?

• accessory muscles

• asynchronous breathing

• nasal flaring

• diaphoresis

• anxiety

What might the parameters be for spontaneous breathing trials?

SBT parameters include CPAP 5cm H2O, or CPAP 0 and PS 5, for 30 min to 2 hours, followed by an ABG.

What actions are taken after a successful SBT and approval?

After a successful SBT and approved ABG results, the patient may be extubated and placed on CAM or nasal cannula.

What are some reasons not to extubate?

• airway edema

• excessive secretions.

What treatments may be used for Glottic Edema?

• Cool aerosol

• racemic Epi and HeO2 may be used to treat glottic edema after extubation.

What happens after passing parameters in tracheostomy weaning?

After passing weaning parameters for tracheostomy weaning, the patient is taken off the vent, the cuff is deflated and they are placed on a trach-collar aerosol.