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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.