Weaning Modes and Protocol. Causes of Ventilator Dependence Assessment for Discontinuation Trial Spontaneous Breathing Trial (SBT) Extubation Criteria Failure of SBT Weaning Modes Weaning Protocols Role of Tracheostomy Long-term Facilities. Stages of Mechanical Ventilation. 2.
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Who is the “ventilator dependent’?
Criteria for discontinuation trial:
Criteria Used in Weaning/Discontinuation in different studies
Measurements used To Predict the Outcome of a Ventilator Discontinuation Effort in More Than One Study
*HR heart rate; Spo2 hemoglobin oxygen saturation.
Spontaneous Breathing Trial
*Values given as No. (%). Pts patients.
PaO2/FiO2 ≥ 200 mm Hg
PEEP ≤ 5 cm H2O
Intact airway reflexes
No need for continuous infusions of vasopressors or inotrops
Stable Support Strategy
RR > 35/min
Spo2 < 90%
HR > 140/min
Sustained 20% increase in HR
SBP > 180 mm Hg, DBP > 90 mm Hg
Low level CPAP (5 cm H2O),
Low levels of pressure support (5 to 7 cm H2O)
Factors affecting ventilator demands
Therapeutic measures to enhance weaning progress
Modes of Partial Ventilator Support
*SIMV synchronized intermittent mandatory ventilation; PSV pressure support ventilation; VS volume support; VAPS(PA) volume assured pressure support (pressure augmentation); MMV mandatory minute ventilation; APRV airway pressure release ventilation.
PSV: Pressure Support
SIMV: synchronized intermittent mandatory ventilation
An acceptable Pmax however has a poor positive predictive value (40% failure to wean in this study with a Pmax more than –20)
Auto PEEP +10
Auto PEEP +10
Although the majority of patients do not require gradual withdrawal of ventilation, those that do tend to do better with graded pressure supported weaning than with abrupt transitions from Assist/Control to CPAP or with SIMV used with only minimal pressure support.