CRITICAL CARE
CRITICAL CARE
CRITICAL CARE
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Central Sydney Health Service Royal Prince Alfred Hospital<br />
WEANING FROM THE MECHANICAL VENTILATION<br />
� The weaning process is initiated by a CPAP trial. This should only occur once each day<br />
if the correct criteria are met (see indications for CPAP trial). It should only be initiated<br />
by the consultant or senior registrar and will usually be initiated on the ward round.<br />
WEANING FAILURE<br />
� Any weaning process (CPAP trial or Pressure Support Weaning) is considered to have<br />
failed if any of the following occur:<br />
� f > 35/min<br />
� Sp02 < 88%<br />
� Respiratory distress is present (more than 2 of the following)<br />
� Pulse >120% of the usual rate for >5 minutes<br />
� Marked use of accessory muscles<br />
� Abdominal paradox<br />
� Diaphoresis<br />
� Marked complaints of dyspnea<br />
� Should weaning failure occur the patient is placed back on CMV until the next day<br />
CPAP TRIAL<br />
� Conduct a CPAP trial daily when all the following are present:<br />
� Fi02 ≤ 0.4 and PEEP ≤ 8 cm H20<br />
� Subject has spontaneous breathing efforts.<br />
It may be necessary to decrease set rate by 50% for 5 minutes to detect respiratory<br />
efforts<br />
� Haemodynamically stable<br />
� To set CPAP of 5 cm H20 and Fi02 0.50<br />
� Set mode on the Dräger to PSV<br />
� Set PS 0 cm H2O<br />
� Set PEEP 5 cm H2O<br />
� Set FiO2 to 0.5<br />
� If f ≤ 35/min for 5 minutes<br />
� Advance to Pressure Support Weaning Procedure<br />
� If f > 35/min in < 5 minutes<br />
� CPAP trial not tolerated<br />
� return to previous CMV ventilator settings and reassess the next morning.<br />
� Occasionally it may be appropriate to repeat the trial after an appropriate intervention<br />
such as suctioning, analgesia, or anxiolysis if these contributed to weaning failure.
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