Weaning from Ventilation

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Weaning Preparation

ETT sizing: Best size ET decreases airway resistance and work of breathing

Weaning Parameters: evaluation of physio mechanics of ventilation and muscle strength, including lung vol and capacities should be done as a a baseline and then daily with SBT

Nutritional Support: Prevent muscle wasting and promote normal electrolyte balance- normal Phosphorus level is imp for diaphragm to function normally

Time on Ventilator: More than 3 days is long term, longer on vent indicates loss of respiratory muscle strength

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Weaning Approaches

T piece or Trach collar

May or may not be done through vent circuit

Frequent monitoring is essential as there are no alarms or back up for ventilation

CPAP

May be done through vent circuit

May be combined with PSV

Pt will continue to receive humidified oxygen and CPA will breathing at their own Vt and rate

SIMV

Vent rate is gradually decreased by 2-4 breaths every hour. Allows for increasing periods of time betwn vent-initiated breaths or decrease in number of vent supported breaths per min

CPAP (aka PEEP) and PS may be adjuncts to SIMV weaning.

PSV

pressure support level is dripped in small increments while still monitoring for consistent Vt. Pressure level needs to be set to allow for sufficient Vt with each spontaneous breath.

Minimal pressure support level is 5-7cm H20 and Vt remains consistent

PSV may be combined with CPAP for weaning

For long term ventilation weaning:

Weaning Intolerance

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Extubation

Removal of ETT

Patient care priorities:

Monitor VS

Monitor LOC

Auscultate lung fields

Observe for signs of respiratory distress

Decannulation

Monitor VS

Monitor LOC

Monitor for inc respiratory effort

Monitor for new onset of dysrhythmias with hemodynamic instability