Monday, 17 July 2017

weaning criteria from ventilator

Principles involved in weaning a patient from ventilatory support in an ICU


Weaning procedures are usually started only after the underlying disease process that necessitated mechanical ventilation has significantly improved or is resolved. The patient should also have an adequate gas exchange , appropriate neurological and muscular status, and stable cardiovascular function.
Weaning indices are objective criteria that are used to predict the readiness of patients to maintain spontaneous ventilation.
The rapid shallow breathing index (f/VT, where 'f' is the respiratory rate and 'VT' is the tidal volume measured during the first minute of a T-piece trial) is superior to conventional parameters in predicting the outcome of weaning while arterial blood gases and respiratory rate.
The intact airway reflexes and a cooperative patient are mandatory prior to completion of the weaning process unless the patient has a cuffed tracheostomy tube.
Mechanical Criteria for weaning/extubation
Criteria                                                                                measurement
Inspiratory pressure                                                         <-25cmH2O
Tidal Volume                                                                       >5ml/kg
Vital Capacity                                                                      >10ml/Kg
Minute Ventilation                                                             <10ml
Rapid Shallow Breathing Index                                          <100

With the patient breathing spontaneously

Adequate oxygenation should be maintained that is the arterial haemoglobin saturation of >90% at FiO2 of 0.4-0.5 with less than 5cm of H2O of PEEP
                              RSBI  =  f(breaths/min) /VT(L)
   Patients with RSBI of 100 or less can be successfully extubated
The most common techniques to wean a patient from the ventilator include SIMV, PRESSURE SUPPORT VENTILATION, low levels of CPAP, spontaneous breathing short periods on T-piece.

No comments:

Post a Comment