Page 570 - Clinical Application of Mechanical Ventilation

536 Chapter 16

room should provide a quiet atmosphere and unlimited visitations. All invasive
monitoring devices/alarms and unnecessary lines and tubes should be removed.
The equipment and supplies that remain should include only the basic vital-sign
monitoring devices, oxygen therapy, and intravenous access for administration of
analgesics and sedatives.

Withdrawal

During the withdrawal process, the family members should be offered an opportu-
nity to stay with the patient. The attending physician and chaplain are encouraged
to be present. Analgesics and sedatives should be provided in sufficient quantity
for patient comfort and relief of anxiety. The ventilator settings may be adjusted
to provide minimal support (e.g., oxygen and humidity only) while the patient is
still intubated. If the ventilator is turned off at this point, the patient is extubated
and put on an oxygen mask to minimize prolonged hypoxia (Seton Healthcare
Network, 2005). The airway is suctioned to ease patient’s breathing efforts. It is
important to document the events following completion of terminal weaning, per
physician’s pronouncement.

SUMMARY

Weaning from mechanical ventilation is not always easy because there are no abso-
lute criteria that can guarantee successful weaning every time. The criteria for wean-
ing provided in this chapter are based on results of research studies and experience
of clinical trials from many sources. While these criteria cannot be expected to be
accurate at all times, they are nevertheless very useful as a guide and a starting point
for weaning trials.
From the review of available literature, it is reasonable to conclude that the more
weaning criteria that are met by a patient, the more likely the weaning process will
be successful. In addition to using as many clinical parameters as feasible, the pa-
tient’s progress should also be monitored on a continuing basis. From these data and
trends, changes and adjustments on the ventilator and treatment plan may then be
made to enhance the weaning outcome.

Self-Assessment Questions

1. Which of the following patient conditions is the least important consideration prior to weaning a patient
from mechanical ventilation?
A. frequent arrhythmias B. ventilatory failure
C. severe acidosis D. use of positive end-expiratory pressure (PEEP)

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