By Sebastian Benavides PGY2
ObjectiveIdentifying patients who are ready to wean
from mechanical ventillationVia clinical criteria
Identifying patient who are not ready for weaning
Knowing the weaning parameters
Defining WeaningProgressive decrease in the amount of
support a patient recieves from the ventilator2 step process
Patients who are ready to wean are identified using a two step predictors of weaning outcome
Weaning is then initiated
Weaning Clinical Criteria:
Cause of respiratory failure improvedPatient is hemodynamic ally stablePatient oxygenating well (SpO2>90% on
FIO2<50%, PEEP< or = to 5)Mental status: Awake and alertAble to initiate inspiratory effort
Weaning Parameters:
RSBI (RR/Vt)<105Mintue Ventilation <15L/minSpontaneous Vt > or = 5ml/kgNegative inspiratory force< or = to -30mm
H2O
Initial WeaningSet pressure support ventillation 1 hr prior to
initiation of weaning:FiO2 at 50%PEEP: must be less than 8Pressure support should be weaned down to 5
WeaningPrior to Extubation:
Confirm minimal FIO2 (less than or equal to 50%) and PEEP equal to 5
Evaluate upper airway comlications Check audible cuff leak (if concern for edema,
stridor) Check if cough and gag are present
Have equipment ready NC/face mask/bipap
Suction secreationsExtubate!
Case62 year old male who weighs 70kg was intubated
3 days ago for hypercapnic respiratory failure Patient is alert, cooperative on the ventilator
over the past 6 hoursHe is on poressure support ventilation with a
tidal volume of 700ml, PS of 10 and an FIO2 of 50%
Upon assessing his weaning parameters, his RSBI is 70, minute ventillation is 10ml/min, his spontaneous tidal volume is 490ml nad NIF is -30mmH2O
CaseWhat would be the following appropriate plan
of action?a) Extubate patient to NCb) Increase pressure support to 15 assess weaning
parameters and extubate after 1 hour c) Decrease pressure support to 5 assess weaning
parameters and extubate after 1 hourd) Increase FIO2 to 60% then extubate after
assessing weaning parameterse) Decrease FIO2 to 40% then extubate after
assessing weaning parameters
CaseC is the correct answer
CaseAnswer: reinitubate and resume mechanical
ventilation
SummaryWhen weaning, remember that patients must
meet clinical criteria. Use your judgment and ask yourself if this patient looks ready to be extubated
Know your weaning parametersRSBI, Minute ventilation, Spontaneous tidal
volume, NIFAlways have equipment ready once extubating
as patient may fail extubation regardless if they meet all the weaning parameters and clinical criteria
Special ThanksWhoever created slides prior to my
adjustmentsThe ICU Book 3rd edition by Paul L. MarinoAngelina Amian (Excellent ICU fellow)