Weaning
Weaning is a process by which the patient is gradually allowed to assume responsibility for regulating and performing his own ventilation.
When to wean?
The initial pulmonary pathology should be resolving
Stable Cardiovascular function
Fluid balance is maintained
Nutritional state maintained without any nitrogen imbalance.
Methods of weaning
T piece and CPAP
Pressure support
SIMV
Weaning criteria
Respiratory rate should be less than 25 breaths/minute
ABG ;PaO2 should be at least 50mmHg on less than 50% oxygen and with no more than 5cm H2O PEEP.
NPO for 4-6 hours
Vital capacity should be at least 10-15 cc/ kg
Negative inspiratory force should be at least -20cm H2O
Tidal volume should be 5ml/kg during spontaneous respiration
Minute ventilation(VTxRR) should be less than 10 liters/ minute
Vital capacity : Is the maximum amount of air a person can expel from the lungs after a maximum inhalation.
Minute ventilation: is the volume of gas inhaled (inhaled minute volume) or exhaled (exhaled minute volume) from a person’s lungs per minute.
Extubation
Obtain the ABG report prior to the weaning criteria
Assemble the oxygen delivery system including mask and humidification
Explain the procedure to the patient and prepare for suction both through ETT and orally
The patient should be positioned 45 degrees head end elevation
Drape should be set for the soiled ETT and to contain secretion
Swab the patient's mouth with an oral Swab dipped in chlorhexidine and then with ice chip depends on patient tolerance.
All fasteners holding the ETT should be loosened.
The ETT should be removed in a steady, quick motion as the patient will likely cough and gag.
Post extubation care:
Humidified oxygen
Respiratory exercise
Assessment and monitoring
Preparation for intubation
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