The Hip: Preservation, Replacement and Revision

Priorities of Weaning from Ventilatory Support

- 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

 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 1:20 pm