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RTH 236 > Weaning > Flashcards

Weaning Flashcards

1
Q

What percentage of patients do not require weaning?

A

80%

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2
Q

What are the components of weaning?

A
  • PPV to reduce WOB
  • oxygen/PEEP to improve oxygenation
  • artificial airway
  • airway management: sxn, bronchial hygiene
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3
Q

What things should you consider before extubation?

A
  • potential airway obstruction (edema, tumors, hematomas)
  • risk of aspiration (supressed gag/cough, fast for 4-6 hours)
  • ability to clear secretions
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4
Q

What are the weaning requirements?

A
  • assess pathophysiology
  • accurately evaluate physiological function
  • be easy to measure
  • require minimum cooperation
  • be easily reproduced
  • be reliable
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5
Q

What clinical factors should you consider before weaning?

A
  • acid/base balance
  • anemia/abnormal hb
  • body temp
  • cardiac arrhythmias
  • fluid balance
  • hemodynamic stability
  • sedation
  • renal function
  • LOC/psych conditions
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6
Q

What should a person’s VC be for weaning?

A

> 15 mL/kg

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7
Q

What should a person’s VE be for weaning?

A

< 10 L/min

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8
Q

What should a person’s VT be for weaning?

A

4-6 mL/kg or 300-700 mL

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9
Q

What should a person’s MVV be for weaning?

A

2 x VE

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10
Q

What should a person’s RR/pattern be for weaning?

A

< 35 b/min, stable

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11
Q

What should a person’s MIP be for weaning?

A

> -20 cmH2O

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12
Q

What should a person’s RSBI be for weaning?

A

< 60-105

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13
Q

What should a person’s P100 be for weaning?

A

< 6 cmH2O

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14
Q

What should a person’s dynamic compliance be for weaning?

A

> 25 mL/cmH2O

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15
Q

What should a person’s VD/VT be for weaning?

A

< 0.6

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16
Q

What should a person’s Qs/Qt be for weaning?

A

< 30%

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17
Q

What should a person’s oxygenation status be for weaning?

A 
FIO2  0.47
PEEP 8
a/A >0.47
A-a < 350 mmHg on 100%
Hb and Cl levels
18
Q

What conditions may affect weaning?

A
  • use of accessary muscles
  • asynchronous breathing
  • diaphoresis
  • anxiety
  • tachypnea
19
Q

What are the methods of weaning?

A
  • SIMV
  • T-piece trials
  • ASV
  • MMV
  • PSV
20
Q

How does SIMV weaning work?

A

provide a back-up MV that is guaranteed to the patient and provides large periodic breaths

21
Q

How does PSV weaning work?

A

it can overcome extra work of the tube and sensitivity

22
Q

How does T-piece weaning work?

A

put patient on t-piece and put vent on standby. don’t need PS and gradually increase time off the vent

23
Q

What is MMV weaning?

A

a mode of ventilation based on a low minimum level of ventilation and if the patient’s efforts exceed that amount, they are spontaneous breaths. if not, they are mechanical breaths.

24
Q

What is ASV weaning?

A

a method of weaning based on a patient’s IBW. reduction of support from 100% to 25%

25
Q

What should you evaluate during a wean trial?

A
  • frequency rise above 30 or 10/min
  • vt below 250 mL
  • change in BP
  • ride in HR more than 20/min
  • clinical signs of deterioration
26
Q

T/F: in patients requiring mechanical ventilation for >12 hours, a search for all the causes that may be contributing to ventilator dependence should be undertaken

A

false; >24 hours

27
Q

T/F: patients receiving mechanical ventilation for resp failure should undergo formal assessment of discontinuation potential if evidence of reversal and adequate oxygenation are present

A

true

28
Q

T/F: formal discontinuation assessments for patients receiving mechanical ventilation for resp failure should be performed during spontaneous breathing rather than while the patient is still receiving substantial ventilatory support

A

true

29
Q

T/F: the removal of the artificial airway from a patient who has been successfully discontinued from ventilatory support should not be based on assessments of airway patency and the ability of the patient to protect the airway

A

false; should be

30
Q

T/F: patients receiving mechanical ventilation for resp failure who fail an SBT should have the cause for the failed SBT determined

A

true

31
Q

T/F: patients receiving mechanical ventilation for resp failure who fail an SBT should receive a stable, non fatiguing, comfortable form of ventilatory support

A

true

32
Q

T/F: anesthesia/sedation strategies and ventilatory management aimed at early extubation should be used in post-surgical patients

A

true

33
Q

T/F: weaning/discontinuation and optimizing sedation protocols that are designed for HCPs don’t have to be developed and implemented by ICUs.

A

false; HAVE to be

34
Q

T/F: tracheotomies should be considered before an initial period of stabilization on the ventilatory when it becomes apparent that the patient will require prolonged ventilator assistance

A

false; after

35
Q

T/F: Weaning strategies in the PMV patient should be fast paced and should include immediate lengthening self-breathing trials

A

false; slow-paced and gradual lengthening

36
Q

T/F: unless there is evidence for clearly irreversible disease, a patient requiring prolonged mechanical ventilatory support for resp failure should not be considered permanently ventilator dependent until 3 months of weaning attempts have failed

A

true

37
Q

T/F: critical care practitioners should familiarize themselves with facilities in their communities, or units in hospitals they staff, that specialize in managing patients who require prolonged dependence on mechanical ventilation

A

true

38
Q

What does “liberated” mean?

A

a person who passes the first wean screen and is extubated quickly (super easy)

39
Q

What does “weaned” mean?

A

a person who requires weaning trials and possibly failed SBT once

40
Q

What does “extended wean” mean?

A

a person who failed weaning trials more than once and is difficult to wean

RTH 236 (21 decks)

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