Weaning
Download
1 / 15

weaning - PowerPoint PPT Presentation


  • 260 Views
  • Uploaded on

weaning. The Discontinuation of Ventilatory Support By Adriana Adams and Cesar Mancillas. What is Weaning?. Weaning is the gradual decrease in the transitional process from total ventilatory support to spontaneous breathing. Reasons for Mechanical Ventilation.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' weaning ' - chogan


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Weaning
weaning

The Discontinuation of Ventilatory Support

By Adriana Adams and Cesar Mancillas


What is weaning
What is Weaning?

  • Weaning is the gradual decrease in the transitional process from total ventilatory support to spontaneous breathing.


Reasons for mechanical ventilation
Reasons for Mechanical Ventilation

  • RESPIRATORY FAILURE SECONDARY TO:

  • Hemodynamically Unstable

  • Airway Protection

  • Neuromuscular Disorders

  • Inadequate Ventilatory Capacity


Methods of weaning
Methods of Weaning

  • SIMV/CPAP Mode

  • PSV

  • T-tube/ATC


Daily screening
DAILY SCREENING

  • Resolved/Improved underlying problem

  • Awake, oriented, Responsive

  • Able to Cough

  • Adequate gas exchange

  • Off Sedations, vasopressor

  • Adequate hemoglobin levels

  • Hemodynamically Stable

  • Airway Patency

  • Ventilation Pump/Capacity adequacy


Airway patency parameters
Airway Patency Parameters

  • Maximal expiratory pressure

  • Peak Expiratory Flow

  • Cough Strength

  • Secretion volume

  • Suctioning frequency

  • Cuff leak test

  • Neurological Function(GCS):


Physiological parameters
Physiological Parameters

  • Rate: <35bpm

  • Maximal Inspiratory Pressure: < -20cmH2O

  • RSBI: r/Vt= <100b/min

  • Vital Capacity: <10-15mL/kg(<15L/min)


Adequate oxygenation parameters
Adequate Oxygenation Parameters

  • PaO2: >60mmHg(at FiO2 of 50%)

  • PEEP: <5-8cmH2O

  • PaO2/FiO2: >200mmHg

  • PaO2/PAo2: >0.50

  • P(A-a)O2: <350mmHg (FiO2max1)

  • %Qs/Qt: <20%

  • pH: >7.25

  • PaCO2: Normal Level

  • SaO2: >90%

  • Hgb: 8-10g/dl


Ventilatory pump parameters
Ventilatory Pump Parameters

  • Vt: >350ml(>4ml/kg)

  • Cd: >25ml/cmH2O

  • Cs: >35ml/cmH2O

  • Ve: <10L/min

  • Vd/Vt: <60%


Simv protocol
SIMV PROTOCOL

  • INITIAL SETTINGS

    • RR: 8/min( <2-4bpm/hr at least BID) until pt is stable at 0-5bpm for 2hrs.

    • PS: 25cmH2O(<2-4/hr) until pt is stable at 0-5cmH2O/min for 2hrs, followed by extubation.

    • *If no resp. disorders, use half hour intervals.

    • *Changes are made as tolerated by patient.


T piece weaning
T-PIECE Weaning

  • Pt may be removed from ventilator or use CPAP

  • T-Piece Trials: Progressive increase in length of time without ventilator support.(increments of 5-10min, then place back on ventilator for remainder of the hour.

  • Until pt is off the vent for 30 min. on and off for 30 min, and so on.

  • Use heated humidifier at desired FiO2(If 50%, consider extubation)

  • If stable for 2hrs, consider extubation.

  • Advantage CPAP use: available alarms, apnea back up settings, and able to monitor patients ventilatory capacity.


Recognizing weaning failure
Recognizing Weaning Failure

  • Tachypnea(>35bpm for >5min)

  • Hypoxemia(<90% saturation)

  • Tachycardia(>140bpm)

  • Bradycardia(If <heart rate by 20%)

  • Hypertension(>180mmHg)

  • Hypotension(<90mmHg)

  • Agitation, diaphoresis, anxiety, signs of >WOB



Extubation video
extubation video

Do not try this at home kids!!!



ad