TSICUBICU Ventilator Weaning Protocol INITIATE VENTILATOR SET UP PEEP 5 5 8 8 10 10 10 12 14 14 14 16 18 20 ABG will be drawn 30 minutes after any rate or volume change Version ID: 823405
Download Pdf The PPT/PDF document "Version: 1 Reviewed: 12/8/2017" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Version: 1 Reviewed: 12/8/2017 TS
Version: 1 Reviewed: 12/8/2017 TSICU/BICU Ventilator Weaning ProtocolINITIATE VENTILATOR SET UP: PEEP 5 5 8 8 10 10 10 12 14 14 14 16 18 20- ABG will be drawn 30 minutes after any rate or volume change Version: 1 Reviewed: 12/8/2017 1. MINIMUM DAILY SCREENING: For possible liberation from the vent (All of the following conditions a. Fi0less than or equal to 40% b. PEEP less than or equal to 5 cmH0) c. cough during suctioning (intact airway reflexes) d. Minimal vasopressor agents e. Minimal sedative agents (intermittent dosing acceptable) 2. Trial of spontaneous breathing: Reference SAT/SBT chart (see below) to make sure all parameters are met.PERFORM CUFF LEAK TEST PRIOR TO PLACING ON PRESSURE SUPPORTCPAP 5 with PS of 5 cmH20-30 minutes 3. Trial will be stopped if ANY of the following conditions are observed: a. RR greater than 35 breath/minute for greater than minutes b. Sa0less than 90% c. Sinus HR greater than 140 beats/minute d. Sustained increase or decrease in HR by greater than or equal to 20% e. Systolic BP greater than 180 mmHg or less than 90 mmHg f. Increased anxiety g. Diaphoresis h. Other If any of the above conditions are observed the trial is considered unsuccessful, place patient on previous ventilator settings If any of the above conditions are not observed the trial is considered successful; obtain weaning parameters Weaning Parameters: NIF better than -20cmH Spontaneous tidal volume greater than 5mL/kg IBW Spontaneous respiratory rate less than 25 breaths per minute Spontaneous minute volume less than 10 L per minute Vital capacity greater than 10mL/kg IBW RSBI less than or equal to 90 (Respiratory Rate / Tidal Volume) 4. Physician will be notified after the spontaneous breathing trial and a decision for extubation will be discussed. If the trial is stopped, the patient will be re
assessed for weaning tolerance the next
assessed for weaning tolerance the next morning. OR when the physician feels the patient is ready Version: 1 Reviewed: 12/8/2017 Version: 1 Reviewed: 12/8/2017 3 of 3 Version: 1 Reviewed: 12/8/2017 1. MINIMUM DAILY SCREENING: For possible liberation from the vent (All of the following conditions a. Fi0less than or equal to 40% b. PEEP less than or equal to 5 cmH0) c. cough during suctioning (intact airway reflexes) d. Minimal vasopressor agents e. Minimal sedative agents (intermittent dosing acceptable) 2. Trial of spontaneous breathing: Reference SAT/SBT chart (see below) to make sure all parameters are met.PERFORM CUFF LEAK TEST PRIOR TO PLACING ON PRESSURE SUPPORTCPAP 5 with PS of 5 cmH20-30 minutes 3. Trial will be stopped if ANY of the following conditions are observed: a. RR greater than 35 breath/minute for greater than minutes less than 90% c. Sinus HR greater than 140 beats/minute d. Sustained increase or decrease in HR by greater than or equal to 20% e. Systolic BP greater than 180 mmHg or less than 90 mmHg f. Increased anxiety g. Diaphoresis h. Other • If any of the above conditions are observed the trial is considered unsuccessful, place patient on previous ventilator settings • If any of the above conditions are not observed the trial is considered successful; obtain weaning parameters Weaning Parameters:• NIF better than -20cmH• Spontaneous tidal volume greater than 5mL/kg IBW • Spontaneous respiratory rate less than 25 breaths per minute • Spontaneous minute volume less than 10 L per minute • Vital capacity greater than 10mL/kg IBW • RSBI less than or equal to 90 (Respiratory Rate / Tidal Volume) 4. Physician will be notified after the spontaneous breathing trial and a decision for extubation will be discussed. If the trial is stopped, the patient will
be reassessed for weaning tolerance the
be reassessed for weaning tolerance the next morning. OR when the physician feels the patient is ready 2 of 3 Version: 1 Reviewed: 12/8/2017 TSICU/BICU Ventilator Weaning ProtocolINITIATE VENTILATOR SET UP: • On arrival place patient on APV/SIMV. Initiate Pulse Oximetry • Initial Tidal Volume is 7milliliters per kilogram of Ideal Body Weight (IBW). • Initial Ventilator Rate 14 • FiO – 100% initially, Weaning FiO to 40% in 10-15 minute increments, while monitoring the Pulse Oximeter Auto-wean FiO to maintain SPOgreater than or equal to 90% • PEEP of 5cmHO if Systolic Blood Pressure is greater than 80mmHg; Peep of 0 if Systolic Blood Pressure is 80 or less • Set initial PS to 10cmH• I:E 1:1.0-1:3.0 ABG will be drawn one hour after mechanical ventilation has been initiated A. Respiratory Acidosis Management: If pH 7.15 – 7.30: Increase set RR until pH greater than 7.30 or PaC0 less than 25 Maximum Set RR = 30) If pH less than 7.15: Increase set RR (maximum 30). If set RR equal 30 and pH 7.15:, tidal volume may be increased in 1 ml/kg (not to exceed 8ml/kgIBW) steps until pH greater than 7.15 B. Respiratory Alkalosis Management: (pH greater than 7.45): Decrease tidal volume by 1ml/kg IBW (no lower than 5cc/kl) If the ABG has critical values, notify ordering physician ARTERIAL OXYGENATION GOAL: Pa055 – 80 mm Hg or Sp0 88 – 90% Use these Fi0/PEEP combinations to achieve oxygenation goal. Fi02 0.3 0.4 0.4 0.5 0.5 0.6 0.7 0.7 0.7 0.8 0.9 0.9 0.9 1.0 PEEP 5 5 8 8 10 10 10 12 14 14 14 16 18 20- ABG will be drawn 30 minutes after any rate or volume change 1 of