Weaning / Discontinuation of  Mechanical Ventilation

      
       

 

          
       
  I wish to evaluate the patient for discontinuation from the ventilator  
   
  Does the patient meet criteria?

  
   
  Place the patient on a Spontaneous Breathing Trial  
   
  Watch for 5 or 10 minutes  

How do I know if the patient is tolerant /intolerant of the trial?

If acute distress does not occur, continue for a maximum of 2 hours

  
   
  Is the patient suitable for extubation?

  

Yes

  

No

Sit the patient up in the bed, suction out the endotracheal tube, explain what you are going to do and extubate the patient.

  

Rest the patient on the ventilator
Ensure optimal analgesia and sedation
  Failure to Ventilate  
  Failure to Oxygenate Reassess failure to wean/discontinue
 

Other Factors             

   

Attempt Spontaneous Breathing Trial ONCE every 24 hours
   
    Recurrent Failure
   
    Consider Tracheostomy:

  • requiring excessive sedation to tolerate ETT

  • marginal mechanics

  • psychological dependence on ventilator

  •  mobility

  • airway trauma.
     
         
                   
       

         
     

       
       

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