Weaning highlihts Flashcards
(15 cards)
Weaning and Discontinuation From Mechanical Ventilation
Terms used
terms that are used describe the process include discontinuation, gradual withdrawal, or liberation
-Types of PTs
-Short termers, Some PTs seem ready for weaning after only 1 or 2 days of ventilation. You should feel free to accelerate the weaning process (or adhere to the protocol of thee facility) for this group of PTs
-Long termers, Pts attached to a vent for more than 3 days are harder to wean because the muscles of ventilation become deconditioned. Also,, the disease that make ventilation of these PTs necessary are usually more serious and requires more time to resolve
-Clinical criteria for weaning
-Review any current difficulties with oxygenation and ventilation
-the readiness of the respiratory muscles to provide the effort required can be evaluated on the facts of measurement of lung mechanics. The following bedside vent parameters should be satisfied before attempting weaning -Rapid shallow breathing index (RSBI) <100 -A Rate (F) 8-20 bpm (during MV) -A peak pressure (during MCV) less than 30 cmH20 -Maximum inspiratory pressure (MIP) -20 cmH20 -Maximum Expiratory Pressure (MEP) 40 cmH20 -VC greater than 10 ml/kg -Spontaneous Tidal Volume > 5 ml/kg
-Clinical measurements
-A-aDO2< 300 TPRR
-Qs/Qt < 20% -Vd/Vt < 60% -Pulse and blood pressure normal -weaning should be deferred until the PaO2 is greater than 60mmHg on an Fi02 less than 50% Side note: RSBI= F/VT
Spontaneous Breathing Trail (SBT)/ Spontaneous Awake Trail (SAT)
-Administer CPAP with or without PSV
-Minimum trail of 30 mins -Maximum trial of 2 hours
-Criteria for termination of SBT
-RR increases to > 35 for 5 min or more
-HR > 140/min or 20% over baseline -cardiac arrhythmias or new arrhythmias -Change in blood pressure -Systolic >180 -Systolic<90 -Excessive agitation -Oxygen sat<90% or decreased by $% or more form baseline -pH < 7.30
-If physiologic parameters show failure of SBT, return the pt to MV for 24 hous
-Rest the pt overnight
-Do not attempt SBT later that day
-Do a leak test
-Make sure there is no edema within the upper airway after removing the ET tube by deflating the cuff and listening
-Weaning methods include
-SIMV
-SIMV with PSV -CPAP -CAP with PSV -T piece
-Drugs that suppress ventilation should be discontinued
-Narcotics
-Neuromuscular blocking agents -Anesthetics
-Assessment of the PT during weaning
-Heart and lungs
-If the HR increases 20 bpm or more from baseline, stop warning and resume MV
-If the HR increases less than 20 bmp, continue weaning and observe closely, may increase the FIO2 -Blood pressure, RR, Vt, and VC should be assessed every 20 minute
-Sensorium
-PT should be alert and responsive
-Any change in mental status or level of consciousness would indicate the need to resume MV -Observe the PT for anxiety, confusion, combativeness, lethargy, unresponsiveness, or loss of consciousness
-Assessment of the PT during weaning cont.
-An ABG should be drawn after 20-30 min to assess the PT ventilation and oxygenation status
-Continuous observation for signs and/ or symptoms of any problems -Auscultation of breath sounds and checking the position/ Patency of the artificial airway is appropriate -Monitor urine output (40-60ml/ hr) -Recommended IPPB or SMI to prevent atelectasis following extubation
Post extubation difficulties
-Hoarseness, sore throat, cough, subglottic edema, increased WOB from secretions, airways obstruction, laryngospasm, aspiration
-Cool-aerosol therapy -Racemic Epinephrine
benzodiazepine antagonist
-The benzodiazepine antagonist flumazenil (Romazicon) can be administered to reverse the effects of benzodiazepines
