- See:
Criteria for Extubation - Decrease FiO2 to less than toxic levels ( < 50%) - Use
PEEP to wean FiO2; - Maintain Hb Sat > 90% - Decrease mechanical
rate: from
IMV of 8 to 4 & check
ABG - Reduces mean intrathoracic pressure and frequency of exposure to Peak Inspiratory Pressure (
PIP); - Minimizes Barotrauma - Improves
V/Q mismatching; - Decrease
PEEP - Increments of 2-3 cm per step; - Check PO2 and/or
Shunt, and if satisfactory, reduce
PEEP; - Allow increments of 6 hrs between successive drops in PEEP; - Decrease PEEP to a base of 5 cm H2O; (approximates end expiratory pressure in extubated patients as a result of epiglottic closure; so called physiologic
PEEP; - If pO2 exceeds 75 mm Hg and pCO2 is less than 45 mm at each setting, then continue to wean; - Attempt "Blow by" (O2 delivery only w/o Pos. Press. Ventilation) - Do not Leave patient on Blow by for longer than 45 min. (patient has to work against resistance of air thru Endotrach tube) - Continue to leave patient on at least 5cm of
PEEP - See
Criteria for Extubation ------------------------
Original Articles: A Comparison of Four Methods of Weaning Patients from Mechanical Ventilation.
