Weaning

Question 1

What’s the criteria for weaning a patient

Answer 1

Respiratory Rate less than 30.
PaCO2 Greater than 60mmHg on 0.4 FiO2.
15ml/kg of tidal volume.
Patient alert and cooperative.
No abdominal distension.
No CVS instability.
Normal pH or PaCO2.

Question 2

Steps to wean patient from tracheostomy

Answer 2

Cuff deflation and swallow assessment with SALT.
Insert fenestrated tube.
Down size the tube.
Capping off.
Decanulation / extubation.

Question 3

Factors that affect weaning from MV.

Answer 3

Fluid balance
Nutritional balance
Anaemia
Fever or infection
Cardiovascular insufficiency
Oversedation
Decreased level of consciousness
Night time ventilation
Increased work of breathing
Impaired respiratory muscle function
Acid-Base imbalance

Question 4

Role of physiotherapy in weaning of patients from MV.

Answer 4

Early assessment of patient’s rehabilitation potential.
Assist with secretion mobilization and clearance
Respiratory muscle strength training
General muscle strength training
Ambulatory ventilation
Identification of readiness for weaning
Assist with tracheostomy weaning.

Question 5

Extubation procedure to be followed by physiotherapy and nurses.

Answer 5

Chest treatment, suction airways and assessment of coughing.
Reintubation equipment and personnel ready
Explanation to patient.
Patient in high sitting.
Clear the mouth and throat of pooled secretions.
Cut tape around ETT/Tracheostomy.
Insert catheter and suction whilst defiating cuff off.
Suction and remove ETT/Tracheostomy tube at peak inspiration.
Encourage patient to cough.
Apply Oxygen via mask and nebulise with bronchodilator and saline.

Question 6

Indications for reintubation

Answer 6

Lack of improvement or worsening of pH or PaCO2.
Decrease in oxygen saturation less than 85% despite use of high FiO2.
Decreased mental status.
Continued respiratory muscle fatigue.
Systolic BP less than 90mmHg despite adequate IV administration of vasopressor.
Patient is unable to clear carplous secretions

Question 7

Consequence of reintubation/extubation failure.

Answer 7

Damage to vocal cords with repeated intubation.
Increases need for tracheostomy
Increases risk of mortality, nasocomial pneumonia and ICU stay