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Crit Care > weaning > Flashcards

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
Q

What should the value be for Qs/Qt for a patient to be weanable?

A

Less than 30% shunt

26
Q

What should you have your FIO2 and Peep at to be considered weanable?

A

FIO2 Less than .40 with low peep

27
Q

What should your P/F ratio show in order for your patient to be considered for weaning?

A

Less than 250

28
Q

What should your patient’s a/A ratio be for a patient to be considered weanable?

A

Less than .47

29
Q

What should a patient’s A-a gradient be to be considered weanable?

A

< 350 mmHg on 100% O2

30
Q

What should your MVV value show in order for patient to be eligible for weaning?

31
Q

What should the Vc be for eligibility for weaning?

A

VC > 15 ml/kg of IBW

32
Q

What should the Ve be for eligibility for weaning?

A

Less than 10 L/min

33
Q

What should the tidal volume be for weaning?

A

4-6 ml/kg or 300 to 700 ml

34
Q

What should your respiratory rate be?

A

Less than 35 beats per min & stable pattern

35
Q

What should the MIP be for weaning?

A

Greater than -20 cmH2O

36
Q

What is the best indicator of ventilator discontinuation potential in the clinical assessment?

A

Patient assessment during 30-120 minute spontaneous breathing trial (RR, HR, Comfort, anxiety, oxygenation, SpO2)

37
Q

When assessing the pathophysiology of a patient for vent discontinuation what is the main factor to address?

A

Why the patient was put on the vent & is that problem resolved

38
Q

What are 5 methods of weaning?

A 
SIMV
PSV
T-Piece
MMV
ASV
39
Q

What is a disadvantage of SIMV weaning?

A

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
Q

Why is PSV a good option?

A

Patient controls rate, timing, depth; it can overcome extra work of tube & sensitivity

41
Q

What is a disadvantage of T-Piece Weaning?

A

Some patients may not be able to tolerate: Heart disease, severe muscle weakness, psych dependence, pre existing chronic lung conditions

42
Q

Which mode of weaning is most difficult to monitor?

43
Q

Name the 6 non respiratory factors to consider in weaning?

A 
Cardiac
Acid base status
Metabolic Function
Drugs
Nutrition
Psychological
44
Q

What effect can underlying cardiac problems have when considering weaning?

A

Left ventricular failure;
Increased preload
Increased venous return
Decreased pulmonary capillary compression as intrathoracic pressure deduced

45
Q

What effect does overfeeding have on ventilation?

A

Causes increased CO2 production which requires increased ventilator demand and high minute ventilation to keep PaCO2 normal

46
Q

What metabolic conditions should you be looking for?

A

Hypothyroidism=decreases ventilator drive
hypophosphatemia=ventilator muscles weakness
hypomagnesemia= muscle weakness

47
Q

What is a measure of hemodynamic instability during weaning?

A

no myocardial ischemia or hypotension; vasopressors if used below 5 mcg of dobutamine or dopamine

48
Q

Name 5 things to look at when evaluating weaning?

A 
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
Q

How is TRC different than PSV

A

TRC will compensate for changes to flow

50
Q

Name 12 recommendations by AARC fpr weaning guidelines

A

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
Q

How long should your SBT last?

A

30-120 minutes

52
Q

What are your weaning ABG’s

A

ph 7.24
CO2 58
HCO3 26

Crit Care (8 decks)

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