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weaning Flashcards

1
Q

What are 4 components in the process of weaning?

A

PPV to decrease WOB
O2/Peep to increase oxygenation
Artificial Airway
Air mgmt.: Suction & bronchial hygiene

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2
Q

Name 3 things you should consider before extubation:

A

Potential airway obstruction
Aspiration risk, is there a gag reflex
No eating
Can they clear secretions

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3
Q

What are the requirements of weaning protocol? Name 6

A 
Assess pathophysiology
Evaluate physiological function
Be easy to measure
Requires minimum cooperation
Be Easily reproduced
Be Reliable
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4
Q

What measurement is effort dependent?
A. Vital Capacity
B. Tidal Volume

A

A. Vital Capacity

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5
Q

What should a good Vc be for a patient before extubation?

A

greater than 15 ml/kg IBW

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6
Q

What is a formula that can be used to determine VC estimate when unable to get patient cooperation?

A

VC=Comp x MIP

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7
Q 
Vital Capacity is a measurement we use to assess a patients:
A.  Oxygenation status
B.  Diffusion
C.  Ventilation to perfusion ability
D.  Muscle strength
A

D. Muscle Strength

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8
Q

What is the normal compliance on a ventilator patient?

A

Approx 50 ml/cm H2o

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9
Q

What is the main difference between TRC & pressure support?

A

With TRC the amount of tube compensation changes with the amount of flow; With pressure support the compensation will not change despite changes to flow

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10
Q

Which type of vent will not allow you to turn off TRC & has it already built into system to compensate for tube resistance?

A

Servo

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11
Q

Name 7 factors that can be used to measure muscle strength

A 
Vital Capacity
Minute Volume 
Tidal Volume 
Max Ventilatory Volume
Respiratory Rate/Respiratory Pattern
Mean Inspiratory Pressure
RSBI:  f/vt
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12
Q

What value is used to assess the drive to breath?

A

P100
Value < 6 cmH2O (Critical)
Normal value < 2

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13
Q

How is a P100 measured?

A

Airway is occluded during first 100 ms of breath; pressure is measured at the mouth= increased pressure is increased drive to breath which can cause fatigue, exhaustion

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14
Q

T or F: The P100 value is independent of the muscle strength of the diaphragm

A

True

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15
Q

What items are used to measure a person’s WOB?

A

C dyn

Vd/Vt

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16
Q

T or F: A patients nutrition would not normally have an effect on a persons work of breathing

A

False; a patients nutrition must be watched

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17
Q

What are some factors used to measure oxygenation?

A 
Qs/Qt value
FIO2 < 40%
Peep is low
P/F ratio
a/A
A-a < 350 mmHg on 100%
Hb level
Cl level
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18
Q

T or F: As long as a person’s Vc is equal to their Vt the patient would be a good candidate to wean & then extubate?

A

False; The VC needs to be larger than the Vt

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19
Q

What type of patient needs weaning?
A. All patients on a ventilator
B. A patient with COPD
C. A patient who is on a ventilator more than 7 days
D. A patient who is on a ventilator more than 14 days

A

C. A patient who is on ventilator more than 7 dayse

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20
Q

What value should your patient’s Cdyn be at to make them a good candidate for weaning?

A

greater than 25 ml/cm H2O

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21
Q 
Cdyn & Vd/Vt is a good way measure:
A.  Oxygenation
B.  WOB
C.  Muscle Strength
D.  patient's drive to breath
22
Q 
What is the best value to use to measure a patient's muscle strength?
A.  RSBI
B.  Vd/Vt
C.  Peep
D.  P100
23
Q

What value for Vd/Vt would you want to see for a patient to be considered weanable?

A

Less than 6 L

24
Q 
What is a variable that you can use to look at a patient's oxygenation?
A.  RSBI
B.  P/F Ratio
C.  P100
D.  Vc
A

B. P/F Ratio

25
What should the value be for Qs/Qt for a patient to be weanable?
Less than 30% shunt
26
What should you have your FIO2 and Peep at to be considered weanable?
FIO2 Less than .40 with low peep
27
What should your P/F ratio show in order for your patient to be considered for weaning?
Less than 250
28
What should your patient's a/A ratio be for a patient to be considered weanable?
Less than .47
29
What should a patient's A-a gradient be to be considered weanable?
< 350 mmHg on 100% O2
30
What should your MVV value show in order for patient to be eligible for weaning?
2 x Ve
31
What should the Vc be for eligibility for weaning?
VC > 15 ml/kg of IBW
32
What should the Ve be for eligibility for weaning?
Less than 10 L/min
33
What should the tidal volume be for weaning?
4-6 ml/kg or 300 to 700 ml
34
What should your respiratory rate be?
Less than 35 beats per min & stable pattern
35
What should the MIP be for weaning?
Greater than -20 cmH2O
36
What is the best indicator of ventilator discontinuation potential in the clinical assessment?
Patient assessment during 30-120 minute spontaneous breathing trial (RR, HR, Comfort, anxiety, oxygenation, SpO2)
37
When assessing the pathophysiology of a patient for vent discontinuation what is the main factor to address?
Why the patient was put on the vent & is that problem resolved
38
What are 5 methods of weaning?
``` SIMV PSV T-Piece MMV ASV ```
39
What is a disadvantage of SIMV weaning?
Too slow; When mandatory rate is reduced to a point where it provides less than 50% or less of min vent then WOB equals that of no support which can cause increase in spont RR
40
Why is PSV a good option?
Patient controls rate, timing, depth; it can overcome extra work of tube & sensitivity
41
What is a disadvantage of T-Piece Weaning?
Some patients may not be able to tolerate: Heart disease, severe muscle weakness, psych dependence, pre existing chronic lung conditions
42
Which mode of weaning is most difficult to monitor?
MMV
43
Name the 6 non respiratory factors to consider in weaning?
``` Cardiac Acid base status Metabolic Function Drugs Nutrition Psychological ```
44
What effect can underlying cardiac problems have when considering weaning?
Left ventricular failure; Increased preload Increased venous return Decreased pulmonary capillary compression as intrathoracic pressure deduced
45
What effect does overfeeding have on ventilation?
Causes increased CO2 production which requires increased ventilator demand and high minute ventilation to keep PaCO2 normal
46
What metabolic conditions should you be looking for?
Hypothyroidism=decreases ventilator drive hypophosphatemia=ventilator muscles weakness hypomagnesemia= muscle weakness
47
What is a measure of hemodynamic instability during weaning?
no myocardial ischemia or hypotension; vasopressors if used below 5 mcg of dobutamine or dopamine
48
Name 5 things to look at when evaluating weaning?
``` Frequency rise above 30 or 10/min Vt below 250 Change in BP (drop of 20 systolic or rise of 30 diastolic) Rise in HR more than 20 min Clinical signs of deterioration ```
49
How is TRC different than PSV
TRC will compensate for changes to flow
50
Name 12 recommendations by AARC fpr weaning guidelines
Pathology of vent dependence evaluated: what caused ventilation & is it fixed Assessment of readiness Assessment is done during SBT Removal of artificial airway based on patency & ability to protect airway Determine cause of failed SBT to correct & redo in 24 hrs After failed SBT, stable vent support, non fatiguing Anesthesia & Sedation strategies with vent mgmt. aimed at early extubation of post op patients Weaning protocals: optimize sedation Trachs used after initial stabilization if prolonged vent needed Patient not classified as vent dependant until after 3 mos Long term care facility familiarity Weaning in long term vent dependent patients should be slow & gradually lengthened
51
How long should your SBT last?
30-120 minutes
52
What are your weaning ABG's
ph 7.24 CO2 58 HCO3 26

Crit Care (8 decks)

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