Weaning

Question 1

What are General considerations with weaning?

Answer 1

• Premature Withrawal

- Delay in Withdrawal

Question 2

What occurs with Premature withdrawal?

Answer 2

• Problems reintubating, respiratory muscle fatigue, compromised gas exchange
• REINTUBTION = 8x increase in nosocomial Pneumonia, 6-12 fold increase in mortality risk

Question 3

What occurs with Delay in withdrawal?

Answer 3

-VAP, Ventlator induced lung injury, discomfort

Question 4

What must we see to determine readiness of weaning?

Answer 4

• Evidence of some reveral of underlying cause of failure
• Oxygenation: P/F ratio >150, FiO2 < .50, PEEP < 8, pH > 7.25
• Hemodynamics: Stable, not on vasopressors, unless low dose
• Patient can initiate breaths, follow commands, and can protect airway

Question 5

What values must be obtained during an SBT trial?

Answer 5

• RR < 30
• Vt 4-6ml/kg
• MV <10 L
• VC > 10ml/kg
• NIF > -30
• RSBI < 105

Question 6

How long are SBTs performed?

Answer 6

30 - 120 minutes

Question 7

If patient has intrinsic PEEP, what may help during an SBT?

Answer 7

CPAP

Question 8

What can show up early and must be monitored for closely at the beginning of an SBT?

Answer 8

Muscle fatigue

Question 9

What qualifies as SBT Failure?

Answer 9

• RR > 30-35
• Vt < 250-300
• HR increased by >20% or over 140
• Systolic BP drop of 20 or rise of 30 or > than 180
• Sudden onset PVC
• Diaphoresis / obvious increased WOB (retracting)
• Poor ABG / oxygenation
• Change in mental status

Question 10

What does Post extubation stridor increase with?

Answer 10

• Duration of mechanical ventilation
• Gender (Female)
• Trauma
• Repeated or traumatic intubations
• Surgery / edema