Weaning Flashcards
What percentage of patients do not require weaning?
80%
What are the components of weaning?
- PPV to reduce WOB
- oxygen/PEEP to improve oxygenation
- artificial airway
- airway management: sxn, bronchial hygiene
What things should you consider before extubation?
- potential airway obstruction (edema, tumors, hematomas)
- risk of aspiration (supressed gag/cough, fast for 4-6 hours)
- ability to clear secretions
What are the weaning requirements?
- assess pathophysiology
- accurately evaluate physiological function
- be easy to measure
- require minimum cooperation
- be easily reproduced
- be reliable
What clinical factors should you consider before weaning?
- acid/base balance
- anemia/abnormal hb
- body temp
- cardiac arrhythmias
- fluid balance
- hemodynamic stability
- sedation
- renal function
- LOC/psych conditions
What should a person’s VC be for weaning?
> 15 mL/kg
What should a person’s VE be for weaning?
< 10 L/min
What should a person’s VT be for weaning?
4-6 mL/kg or 300-700 mL
What should a person’s MVV be for weaning?
2 x VE
What should a person’s RR/pattern be for weaning?
< 35 b/min, stable
What should a person’s MIP be for weaning?
> -20 cmH2O
What should a person’s RSBI be for weaning?
< 60-105
What should a person’s P100 be for weaning?
< 6 cmH2O
What should a person’s dynamic compliance be for weaning?
> 25 mL/cmH2O
What should a person’s VD/VT be for weaning?
< 0.6
What should a person’s Qs/Qt be for weaning?
< 30%
What should a person’s oxygenation status be for weaning?
FIO2 0.47 PEEP 8 a/A >0.47 A-a < 350 mmHg on 100% Hb and Cl levels
What conditions may affect weaning?
- use of accessary muscles
- asynchronous breathing
- diaphoresis
- anxiety
- tachypnea
What are the methods of weaning?
- SIMV
- T-piece trials
- ASV
- MMV
- PSV
How does SIMV weaning work?
provide a back-up MV that is guaranteed to the patient and provides large periodic breaths
How does PSV weaning work?
it can overcome extra work of the tube and sensitivity
How does T-piece weaning work?
put patient on t-piece and put vent on standby. don’t need PS and gradually increase time off the vent
What is MMV weaning?
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.
What is ASV weaning?
a method of weaning based on a patient’s IBW. reduction of support from 100% to 25%
What should you evaluate during a wean trial?
- 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
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
false; >24 hours
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
true
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
true
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
false; should be
T/F: patients receiving mechanical ventilation for resp failure who fail an SBT should have the cause for the failed SBT determined
true
T/F: patients receiving mechanical ventilation for resp failure who fail an SBT should receive a stable, non fatiguing, comfortable form of ventilatory support
true
T/F: anesthesia/sedation strategies and ventilatory management aimed at early extubation should be used in post-surgical patients
true
T/F: weaning/discontinuation and optimizing sedation protocols that are designed for HCPs don’t have to be developed and implemented by ICUs.
false; HAVE to be
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
false; after
T/F: Weaning strategies in the PMV patient should be fast paced and should include immediate lengthening self-breathing trials
false; slow-paced and gradual lengthening
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
true
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
true
What does “liberated” mean?
a person who passes the first wean screen and is extubated quickly (super easy)
What does “weaned” mean?
a person who requires weaning trials and possibly failed SBT once
What does “extended wean” mean?
a person who failed weaning trials more than once and is difficult to wean
