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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.