CRITICAL CARE
CRITICAL CARE
CRITICAL CARE
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Central Sydney Health Service Royal Prince Alfred Hospital<br />
� In CareVue record on the “CPAP trial” line (ventilation window) whether the CPAP<br />
trial was PASSED or FAILED<br />
PRESSURE SUPPORT (PS) WEANING PROCEDURE<br />
Initial Pressure support settings:<br />
� Set PEEP 5 cm H20 and Fi02 0.5<br />
� Set initial PS based on f during CPAP trial:<br />
� If CPAP f < 25 /min<br />
� Set PS 10 cm H20<br />
� If CPAP f = 25-35 /min:<br />
� Set PS 20 cm H20<br />
Subsequent pressure support weaning settings:<br />
� Subsequent Pressure Support adjustments are made on respiratory rate (f) every 10-<br />
15min<br />
� If f > 25 increase Pressure Support by 2 to 5 cm H2O<br />
� Maximum pressure allowed, PEEP + PS = 30 cm H2O<br />
� Pressure airway alarm should be at 35 cm H2O<br />
� If f < 20 decrease Pressure Support by 2-5 cm H2O<br />
� If f > 35 and/or PEEP + PS > 30 cm H2O weaning has failed and CMV is initiated as<br />
above<br />
Subsequent Oxygen and PEEP Adjustments:<br />
� Adjustments are made as per Oxygenation Goals outlined above<br />
� If FiO2 > 0.5 and PEEP > 10 cm H2O are required while on pressure support ventilation,<br />
strong consideration should be given to reinitiating CMV as above. Inform the medical<br />
staff.<br />
EXTUBATION / SWEDISH NOSE VENTILATION<br />
� Extubation or spontaneous ventilation via a Swedish nose and tracheostomy should be<br />
considered if the following criteria are met.<br />
� f < 30 on Pressure support 5-7 cm H2O<br />
� Oxygenation goals are met with<br />
� PEEP of 5 cm H2O<br />
� FiO2 of 0.4 or less