CRITICAL CARE

More documents

Recommendations

Info

Central Sydney Health Service Royal Prince Alfred Hospital WEANING FROM THE MECHANICAL VENTILATION � The weaning process is initiated by a CPAP trial. This should only occur once each day if the correct criteria are met (see indications for CPAP trial). It should only be initiated by the consultant or senior registrar and will usually be initiated on the ward round. WEANING FAILURE � Any weaning process (CPAP trial or Pressure Support Weaning) is considered to have failed if any of the following occur: � f > 35/min � Sp02 < 88% � Respiratory distress is present (more than 2 of the following) � Pulse >120% of the usual rate for >5 minutes � Marked use of accessory muscles � Abdominal paradox � Diaphoresis � Marked complaints of dyspnea � Should weaning failure occur the patient is placed back on CMV until the next day CPAP TRIAL � Conduct a CPAP trial daily when all the following are present: � Fi02 ≤ 0.4 and PEEP ≤ 8 cm H20 � Subject has spontaneous breathing efforts. It may be necessary to decrease set rate by 50% for 5 minutes to detect respiratory efforts � Haemodynamically stable � To set CPAP of 5 cm H20 and Fi02 0.50 � Set mode on the Dräger to PSV � Set PS 0 cm H2O � Set PEEP 5 cm H2O � Set FiO2 to 0.5 � If f ≤ 35/min for 5 minutes � Advance to Pressure Support Weaning Procedure � If f > 35/min in < 5 minutes � CPAP trial not tolerated � return to previous CMV ventilator settings and reassess the next morning. � Occasionally it may be appropriate to repeat the trial after an appropriate intervention such as suctioning, analgesia, or anxiolysis if these contributed to weaning failure.
Central Sydney Health Service Royal Prince Alfred Hospital � In CareVue record on the “CPAP trial” line (ventilation window) whether the CPAP trial was PASSED or FAILED PRESSURE SUPPORT (PS) WEANING PROCEDURE Initial Pressure support settings: � Set PEEP 5 cm H20 and Fi02 0.5 � Set initial PS based on f during CPAP trial: � If CPAP f < 25 /min � Set PS 10 cm H20 � If CPAP f = 25-35 /min: � Set PS 20 cm H20 Subsequent pressure support weaning settings: � Subsequent Pressure Support adjustments are made on respiratory rate (f) every 10- 15min � If f > 25 increase Pressure Support by 2 to 5 cm H2O � Maximum pressure allowed, PEEP + PS = 30 cm H2O � Pressure airway alarm should be at 35 cm H2O � If f < 20 decrease Pressure Support by 2-5 cm H2O � If f > 35 and/or PEEP + PS > 30 cm H2O weaning has failed and CMV is initiated as above Subsequent Oxygen and PEEP Adjustments: � Adjustments are made as per Oxygenation Goals outlined above � If FiO2 > 0.5 and PEEP > 10 cm H2O are required while on pressure support ventilation, strong consideration should be given to reinitiating CMV as above. Inform the medical staff. EXTUBATION / SWEDISH NOSE VENTILATION � Extubation or spontaneous ventilation via a Swedish nose and tracheostomy should be considered if the following criteria are met. � f < 30 on Pressure support 5-7 cm H2O � Oxygenation goals are met with � PEEP of 5 cm H2O � FiO2 of 0.4 or less
Page 1 and 2: Central Sydney Health Service Royal
Page 3: Central Sydney Health Service Royal

CRITICAL CARE

Create successful ePaper yourself

Delete template?

Save as template?