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| ==Weaning==
| | {{ACM}} {{SemRikken}} |
| ===Overview===
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| Weaning of mechanical ventilator is gradual withdrawal of
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| ventilatory support through utilization of a variety of ventilator modes,
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| periods of total spontaneous ventilation, and appropriate rest periods for
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| muscle unloading. Discontinuation of mechanical ventilation should occur as
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| soon as the patient is able to protect his/her airway and sustain a
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| physiologically-competent minute ventilation while important indicators of
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| disease show resolution.
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| The plan of weaning is not static but requires
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| continual reassessment so that the particular ventilatory needs of the patient
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| are met while the disease process is corrected. Bedside measures of
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| cardiopulmonary function aid in the assessment of weaning fitness; these
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| should not take the place of careful bedside observation and "hands-on" care,
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| however. Patients should not be allowed to fatigue during weaning trials, and
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| interventions to ensure an adequate nutritional status and good bronchial
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| hygiene should be applied.
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| 1.2 Indications: The mechanically ventilated
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| ===criteria for Spontaneous Breathing Trial (SBT)===
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| *Respiratory Criteria
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| #PaO2>= '''60 mm hg''' ( FiO2<40-50,PEEP<5-8cm H2O)
| | ''SANDBOX'' |
| #PaCo2 normal or base line
| | [[File:Captura de Pantalla 2024-05-18 a la(s) 9.33.11 p.m..png]] |
| #Pt able to initiate inspiratory effort
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| *Cardiovascular Criteria
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| #No evidence of myocardial ischemia
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| #HR<140/min
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| #BP normal without vasopressor or minimal vasopressor support
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| #Adequate mental status :''arousable/GCS.13''
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| *Absence of correctable comorbid conditions
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| #Patient is afebrile
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| #No significant electrolytes abnormalities
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| ===Patient who will tolerate Weaning===
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| the criteria that predict the patient tolerance to weaning are
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| #Tidal volume :5-7 ml/Kg
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| #respiratory rate is :10-18 per minute
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| #total ventilation:5-6 L /min
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| #RR/Vt ratio :40-50/L
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| #'''MIP''' ( maximum inspiration pressure )between 90- to -120 cm H2O
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_9.33.11_p.m..png)