Page 16 - Critical Care Notes

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BASICS
■ Provide communication methods for patients, and communicate freely with
families.
■ Prevent infection including catheter-associated urinary tract infection
(CAUTI), central catheter-associated bloodstream infection (CLABSI), and
ventilator-associated pneumonia (VAP) (refer to VAP guidelines in
Respiratory tab).
■ Assess readiness to wean.
Weaning
Sample Criteria for Weaning: Readiness
■ Alert and cooperative
■ FIO 2 <40%–50% and PEEP <5–8 cm H 2 O
■ Hemodynamically stable with HR <120 bpm and no significant arrhythmias,
SBP >100 mm Hg
■ pH >7.34
■ PaO 2 >80 mm Hg
■ PaCO 2 <45 mm Hg
■ PaO 2 /FIO 2 ratio >200
■ ETCO 2 <40 mm Hg
■ Vital capacity 15 mL/kg and minute ventilation <10
■ Hemoglobin >7–9 g/dL and serum electrolytes within normal limits
■ Spontaneous respirations >6 bpm or <35 bpm
■ Negative inspiratory pressure –30 cm H 2 O
■ Relatively afebrile with limited respiratory secretions and good cough reflex
■ Good pain management
■ Inotropes reduced or unchanged within previous 24 hr
■ Sedation discontinued
■ Spontaneous breathing trials (SBT)
Weaning Protocol

Hospital Weaning Protocol Patient’s Readiness for Weaning

Continued
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