W3 D1 - Weaning and Extubation Flashcards
What are signs that the patient is ready to be weaned off ventilation?
Stable LOC, awake
Hemodynamic stability
Corrected physiologic conditions
Breathing on their own
oxygenation
RR below 30
Tidal volumes in range
Problem requiring ventilation is resolved
What are indicators of intolerance to weaning?
Respiratory
* dyspnea
* cyaosis
* accessory muscles
Cardiac
* tachycardia
* hypertension
* arrhythmias
Neuro
* change in LOC
* restless
* agitated
etc etc
What factors contribute to successful weaning?
- Letting the patient rest when tired
- Ambulating when possible
- Screen visitors
- ABGs 30 mins in
- good night sleep
- start wean in the morning
What is SBT?
Spontaneous breathing trial
* diagnostic tool to determine if they can breathe on their own
* RT measures rapid shallow breathing index after 2 mins; less than 110
Screening
* spontaneous inspiratory effort
* PF ratio great than 200
* FiO2 less than 0.50
* Peep less than 10
* Levo less than 0.2 mcg
* No more than 1 vasoactive drug
* stable neurological status
How do you calculate PF ratio?
PaO2/FiO2
Ex. 80/0.21 = 380
Discuss pressure support wean and prolonged mechanical ventilation weaning options
Pressure support wean
* slowly wean the amount of pressure support
Prolonged mechanical ventilation more than 21 days
* slow changes less than 2 PS per day
* slowly increase time with the vent off
* rest overnight
What are the criteria for extubation?
Hemodynamically stable
Gas exchange
Respiratory assessment
* must have cuff leak
* less than 40% FiO2
* cough and gag
How do you prepare for extubation?
Precautions for yourself
* Prepare face mask
* Ensure yankauer and ambu bag ready
During extubation
* hyperoxygenate
* suction mouth after
* place on oxygen via facemask as needed
Post extubation
* assess airway, monitor for larngeal edema
* send ABG 30 mins after
* encourage deep breathing
* inform patient of sore throat and hoarse voice
