|
|
| (215 intermediate revisions by 20 users not shown) |
| Line 1: |
Line 1: |
| ==Weaning==
| | {{ACM}} {{SemRikken}} |
| ===Overview===
| |
| Weaning of mechanical ventilator is gradual withdrawal of
| |
| ventilatory support through utilization of a variety of ventilator modes,
| |
| periods of total spontaneous ventilation, and appropriate rest periods for
| |
| muscle unloading. Discontinuation of mechanical ventilation should occur as
| |
| soon as the patient is able to protect his/her airway and sustain a
| |
| physiologically-competent minute ventilation while important indicators of
| |
| disease show resolution.
| |
| The plan of weaning is not static but requires
| |
| continual reassessment so that the particular ventilatory needs of the patient
| |
| are met while the disease process is corrected. Bedside measures of
| |
| cardiopulmonary function aid in the assessment of weaning fitness; these
| |
| should not take the place of careful bedside observation and "hands-on" care,
| |
| however. Patients should not be allowed to fatigue during weaning trials, and
| |
| interventions to ensure an adequate nutritional status and good bronchial
| |
| hygiene should be applied.
| |
|
| |
|
| ===criteria for Spontaneous Breathing Trial (SBT)===
| |
| Trials of spontaneous breathing assess a patient’s ability to breathe while receiving
| |
| minimal or no respiratory support. To accomplish this, ventilators are switched
| |
| from full respiratory support modes such as volume-assist control or pressure
| |
| control to ventilatory modes such as pressure support, continuous positive airway
| |
| pressure (CPAP), or ventilation with a T-piece (in which there is no positive endexpiratory
| |
| pressure). Ideally, a trial of spontaneous breathing is initiated while the
| |
| patient is awake and not receiving sedative infusions.
| |
| The typical readiness criteria for SBT are
| |
| *Respiratory Criteria
| |
|
| |
|
| #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
| |
| | |
| *Cardiovascular Criteria
| |
| #No evidence of myocardial ischemia
| |
| #HR<140/min
| |
| #BP normal without vasopressor or minimal vasopressor support
| |
| #Adequate mental status :''arousable/GCS.13''
| |
| *Absence of correctable comorbid conditions
| |
| #Patient is afebrile
| |
| #No significant electrolytes abnormalities
| |
| | |
| ===Patient who will tolerate Weaning===
| |
| the criteria that predict the patient tolerance to weaning are
| |
| #Tidal volume :5-7 ml/Kg
| |
| #respiratory rate is :10-18 per minute
| |
| #total ventilation:5-6 L /min
| |
| #RR/Vt ratio :40-50/L
| |
| #'''MIP''' ( maximum inspiration pressure )between 90- to -120 cm H2O
| |
| ===Rapid shallow breathing index===
| |
| #RR/Vt ratio(normally 40-50/L)
| |
| #Threshold RR/Vt of approximately 100/L
| |
| #Predictive of successful weaning(below 105/L 80% success)
| |
| #Failure of weaning(above105/L 95% failure)
| |
| | |
| ===maximum inspiratory pressure===
| |
| It 's used as Evaluation of diaphragm and other muscles of inspiration , Normal values usually are (-90 to -120 cm H2O) Threshold -20 cmH2O Identifying Pts who will not tolerate SBT Below threshold(less negative than -20)no successful weaning Above threshold(more negative than -20)40% did not wean
| |
| | |
| ===Spontaneous breathing trial===
| |
| ===Approach to rapid breathing===
| |
_9.33.11_p.m..png)