Weaning Flashcards by Hannah Taylor

What percentage of patients do not require weaning?

80%

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What are the components of weaning?

PPV to reduce WOB
oxygen/PEEP to improve oxygenation
artificial airway
airway management: sxn, bronchial hygiene

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What things should you consider before extubation?

potential airway obstruction (edema, tumors, hematomas)
risk of aspiration (supressed gag/cough, fast for 4-6 hours)
ability to clear secretions

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What are the weaning requirements?

assess pathophysiology
accurately evaluate physiological function
be easy to measure
require minimum cooperation
be easily reproduced
be reliable

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What clinical factors should you consider before weaning?

acid/base balance
anemia/abnormal hb
body temp
cardiac arrhythmias
fluid balance
hemodynamic stability
sedation
renal function
LOC/psych conditions

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What should a person’s VC be for weaning?

> 15 mL/kg

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What should a person’s VE be for weaning?

< 10 L/min

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What should a person’s VT be for weaning?

4-6 mL/kg or 300-700 mL

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What should a person’s MVV be for weaning?

2 x VE

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What should a person’s RR/pattern be for weaning?

< 35 b/min, stable

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What should a person’s MIP be for weaning?

> -20 cmH2O

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What should a person’s RSBI be for weaning?

< 60-105

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What should a person’s P100 be for weaning?

< 6 cmH2O

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What should a person’s dynamic compliance be for weaning?

> 25 mL/cmH2O

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What should a person’s VD/VT be for weaning?

< 0.6

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What should a person’s Qs/Qt be for weaning?

< 30%

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What should a person’s oxygenation status be for weaning?

FIO2  0.47
PEEP 8
a/A >0.47
A-a < 350 mmHg on 100%
Hb and Cl levels

What conditions may affect weaning?

use of accessary muscles
asynchronous breathing
diaphoresis
anxiety
tachypnea

What are the methods of weaning?

SIMV
T-piece trials
ASV
MMV
PSV

How does SIMV weaning work?

provide a back-up MV that is guaranteed to the patient and provides large periodic breaths

How does PSV weaning work?

it can overcome extra work of the tube and sensitivity

How does T-piece weaning work?

put patient on t-piece and put vent on standby. don’t need PS and gradually increase time off the vent

What is MMV weaning?

a mode of ventilation based on a low minimum level of ventilation and if the patient’s efforts exceed that amount, they are spontaneous breaths. if not, they are mechanical breaths.

What is ASV weaning?

a method of weaning based on a patient’s IBW. reduction of support from 100% to 25%

What should you evaluate during a wean trial?

- frequency rise above 30 or 10/min - vt below 250 mL - change in BP - ride in HR more than 20/min - clinical signs of deterioration

T/F: in patients requiring mechanical ventilation for >12 hours, a search for all the causes that may be contributing to ventilator dependence should be undertaken

false; >24 hours

T/F: patients receiving mechanical ventilation for resp failure should undergo formal assessment of discontinuation potential if evidence of reversal and adequate oxygenation are present

true

T/F: formal discontinuation assessments for patients receiving mechanical ventilation for resp failure should be performed during spontaneous breathing rather than while the patient is still receiving substantial ventilatory support

true

T/F: the removal of the artificial airway from a patient who has been successfully discontinued from ventilatory support should not be based on assessments of airway patency and the ability of the patient to protect the airway

false; should be

T/F: patients receiving mechanical ventilation for resp failure who fail an SBT should have the cause for the failed SBT determined

true

T/F: patients receiving mechanical ventilation for resp failure who fail an SBT should receive a stable, non fatiguing, comfortable form of ventilatory support

true

T/F: anesthesia/sedation strategies and ventilatory management aimed at early extubation should be used in post-surgical patients

true

T/F: weaning/discontinuation and optimizing sedation protocols that are designed for HCPs don't have to be developed and implemented by ICUs.

false; HAVE to be

T/F: tracheotomies should be considered before an initial period of stabilization on the ventilatory when it becomes apparent that the patient will require prolonged ventilator assistance

false; after

T/F: Weaning strategies in the PMV patient should be fast paced and should include immediate lengthening self-breathing trials

false; slow-paced and gradual lengthening

T/F: unless there is evidence for clearly irreversible disease, a patient requiring prolonged mechanical ventilatory support for resp failure should not be considered permanently ventilator dependent until 3 months of weaning attempts have failed

true

T/F: critical care practitioners should familiarize themselves with facilities in their communities, or units in hospitals they staff, that specialize in managing patients who require prolonged dependence on mechanical ventilation

true

What does "liberated" mean?

a person who passes the first wean screen and is extubated quickly (super easy)

What does "weaned" mean?

a person who requires weaning trials and possibly failed SBT once

What does "extended wean" mean?

a person who failed weaning trials more than once and is difficult to wean