Weaning Neonates from Mech. Ventilation

Question 1

What do you assess when considering weaning a babe off of vents?

Answer 1

WOB is low
- are they grunting?

Question 2

How do you manage weaning Pts off vents?

Answer 2

If WOB is low, challenge the Pt by:
- Decreasing RR and PEEP (on PRVC)
- Watch for Pts. PIP to be low (indicating high compliance)
- watch for apnea and bradycardia periods
- watch for weight gain

Question 3

Why do we want to take over a babes WOB?

Answer 3

So their body can focus on growing. sick infants have a hard time putting weight on.

Question 4

What is the Order of Weaning?

Answer 4

• Wean volume to 4 ml/kg, If using PCV mode, wean PIP < 18
• Adjust PEEP and Ti based on waveforms and CxR
• wean set rate to 20 bpm(by increments of 5-10)
• Pt is breathing comfortably, hemodynamically stable, no significant increase in TcPCO2 or EtCO2 (if applicable) for 1 hour prior to extubating

Question 5

If babe is performing well on 20BPM (RR), can you remove the tube?

Answer 5

Yes

Question 6

When a babe is approved for extubating, what are the following steps/preparations needed?

Answer 6

1. Ensure caffeine is optimized
2. Minimal handling of Pt. for 1 hr
3. once extubating order is received, ensure it is done under 60 seconds.
4. prepare for CPAP

Question 7

why is caffeine optimization dependent on?

Answer 7

Weight.
- kids are weighed daily, so you need to adjust the dose daily

Question 8

How long do you need to let the kid/babe rest before extubation?

Answer 8

1 hr

Question 9

When extubating, what should you have going/ready?

Answer 9

CPAP so there no loss of pressure