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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Criteria for Extubation


- See: Priorities of Weaning from Ventilatory Support Vital Capacity > 15 cc/kg Negative Inspiratory Force < -25 cm H2O Respiratory rate < 30 Spontaneous Tidal vol > 5 cc/kg (may not be important) 48 % false negative prediction of outcome; PaO2 > 300 mm Hg on FiO2 of 100%; Trial of room air @CPApp4fvn[CPAP: 
- IMV rate of 0, FiO2 of 21%, & CPAP of 5 cm H20; After 1/2 hr, extubate if: 
- PaO2 > 55 torr (FiO2 = 21%); 
- Ventilatory rate < 30 - pH > 7.35 - pCO2 < 45 torr 94 % predictive of patient tolerating extubation; Priorities of Weaning from Ventilatory Support: 
- appearance: no apprehension or diaphoresis 
- consciousness: alert and responsive to verbal commands 
- mean arterial pressure > 80 mm Hg 
- mean left atrial pressure (wedge) less than 18 mm Hg 
- minmal bleeding 
- normal body temperature 
- FiO2 less than 0.5 w/ a pO2 > 80 mm Hg 
- PEEP < 5 cm or less 
- no untreated arrhythmia 
- spontaneous tidial vol > 5 ml/kg 
- spontaneous vital capacity > 10 ml/kg 
- spontaneous respiratory rate less than 30 / min 
- negative inspiratory force greater than 25 cm 
- mean time to extubation can be decreased by as much as 41% using a protocol, which can also reduce arterial blood gas sampling rates; 
- PaO2 maintained > 80 mm Hg 
- FiO2 set to give a pO2 of 150 mm Hg in the first two hours 
- FiO2 set to give a pO2 of 110 mm Hg thereafter; 
- pCO2 maintained < 45 mm Hg 
- pH maintained between 7.35 and 7.50 
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A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, May 22, 2012 1:12 pm