Weaning for extubation

Question 1

Weaning criteria?

Answer 1

• make sure they have an intact ventilatory drive
• good A-a Gradient (5-10)
• Intact ventilatory drive
• Ability to maintain a patent airway; Good cough and gag
• Good oxygenation status
• WOB + good LOC
• stable vitals
• positive leak test
• P/F Ratio > 300
• Passed SBT

Question 2

How long should nutritional feeds be disconnecting before extubation?

Answer 2

Feeds should be d/c 4-6 hours before extubating

Question 3

What does a positive leak test indicate?

Answer 3

A good seal

Question 4

How long should a SBT trial be conducted? (2)

Answer 4

1. <3 days = 30 mins
2. > 3 days = 1-1.5 hour

Question 5

Settings for SBT trial?

Answer 5

Pressure support mode with the following settings:

• PEEP = 5
• PS = 0
• FiO2 < 0.4
• ABG obtained at the end of SBT

Question 6

What needs to be checked after a SBT?

Answer 6

ABG

Question 7

Failed SBT criteria?

Answer 7

RR > 35 for >5min

• SaO2 <90% for >30sec
• HR > 140
• Systolic BP >180 or <90
• Cardiac dysrhythmia
• pH < 7.32

Question 8

Causes of failed SBTs?

Answer 8

Question 9

How do you calculate Tobin score?

Answer 9

RR/Vt

• Convert Vt to litres for calc
• <105 is good; if it gets closer to 80; wait for longer to be sure
• > 105 = fail