Page 17 - Critical Care Notes

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Weaning Protocol—cont’d

Hospital Weaning Protocol Patient’s Readiness for Weaning

Weaning Methods
■ T-tube weaning: Place patient on T-tube circuit on same FIO 2 as on ventilatory
assistance. Monitor ABGs after 30 min. Provide a brief rest period on the
ventilator as needed and continue to monitor ABGs until satisfactory.
Extubate when patient is rested, has good spontaneous respiratory effort,
and ABGs within acceptable parameters.
■ SIMV weaning: Decrease SIMV rate every 1–4 hr or 2 breaths/min. Monitor
spontaneous breaths, SpO 2 with a goal of >90%, ETCO 2 , hemodynamics, and
ECG for dysrhythmias. Obtain ABGs within 30 min of ventilator change.
Allows for gradual change from positive pressure ventilation to sponta-
neous pressure ventilation. Titrate FIO 2 .
■ PSV: Use low levels of PSV (5–10 cm H 2 O). Decrease in 3–6 cm of H 2 O incre-
ments. Useful in retraining respiratory muscles from long-term ventilation.
■ CPAP/BiPAP: Provides expiratory support, maintains positive intrathoracic
pressure. BiPAP adds inspiratory support to CPAP. Prevents respiratory muscle
fatigue.
Nursing Assessment During Weaning
■ Vital signs and hemodynamic stability (PAS, PAD, PCWP, CO, CI)
■ Dysrhythmias or ECG changes
■ Oxygenation/efficiency of gas exchange: SaO 2 >90% on <40% FIO 2
■ CO 2 production and elimination
■ pH level
■ Bedside pulmonary function tests
■ Work of breathing including use of accessory muscles
■ Adequate clearing of airway though effective coughing
■ Level of fatigue
■ Patient discomfort
■ Adequate nutrition
BASICS