The document discusses the process of weaning patients off ventilators. It involves three stages: withdrawing the patient from dependence on the ventilator, removing the tube, and finally removing oxygen support. Several criteria are used to assess patient readiness for weaning, including vital capacity, tidal volume, and rapid shallow breathing index. Different methods of weaning are outlined, including modes like assist-control, IMV, SIMV and modes involving pressure support. Nursing roles involve close monitoring, adjusting support levels, and watching for signs of fatigue or deterioration. Nutrition, pulmonary care and assessing readiness to remove the tube and oxygen are also discussed.

1. Ventilator weaning By. Mr. Kim Monteiro. R.N. B.Sc N Dual role nurse practitioner

2. Respiratory weaning :- The process of withdrawing the patient from dependence on the ventilator.

4. Weaning is started when the patient is recovering from the acute stage of medical and surgical problems and when the cause of respiratory failure is sufficiently reversed . When is weaning initiated ?????

5. Collaborative Effort:- Successful weaning physician respiratory therapist nurse

6. Criteria for Weaning Careful assessment is required to determine whether the patient is ready to be removed from mechanical ventilation.

7. Weaning indices to be assessed:- • Vital capacity : the amount of air expired after maximum inspiration. Used to assess the patient’s ability to take deep breaths. Vital capacity should be 10 to 15 mL/kg to meet the criteria for weaning. • Maximum inspiratory pressure (MIP): used to assess the patient’s respiratory muscle strength. It is also known as negative inspiratory pressure and should be at least −20 cm H2O. • Tidal volume : volume of air that is inhaled or exhaled from the lungs during an effortless breath. It is normally 7 to9 mL/kg. • Minute ventilation : equal to the respiratory rate multiplied by tidal volume. Normal is about 6 L/min. • Rapid/shallow breathing index : used to assess the breathing pattern and is calculated by dividing the respiratory rate by tidal volume. Patients with indices below 100 breaths/min/L are more likely to be successful at weaning .

9. Patient Preparation Physiological consideration :- #The nurse must consider the patient as a whole, taking into account factors that impair the delivery of oxygen and elimination of carbon dioxide as well as those that increase oxygen demand (sepsis, seizures, thyroid imbalances) or decrease the patient’s overall strength (nutrition,neuromuscular disease). Psychological consideration:- # The nurse explains what will happen during weaning and what role the patient will play in the procedure. The nurse emphasizes that someone will be with or near the patient at all times, and answers any questions simply and concisely.

10. Proper preparation of the patient can reduce the weaning time

11. Methods of Weaning

25. If the patient appears to be tolerating the T-piece trial, a second set of arterial blood gas measurements is drawn 20 minutes after the patient has been on spontaneous ventilation at a constant FiO2 pressure support ventilation. (Alveolar–arterial equilibration takes 15 to 20 minutes to occur.) Signs of exhaustion and hypoxia correlated with deterioration in the blood gas measurements indicate the need for ventilatory support. The patient is placed back on the ventilator each time signs of fatigue or deterioration develop. If clinically stable, the patient usually can be extubated within 2 or 3 hours of weaning and allowed spontaneous ventilation by means of a mask with humidified oxygen .

26. Successful weaning from the ventilator is supplemented by intensive pulmonary care. The following are continued: • Oxygen therapy • Arterial blood gas evaluation • Pulse oximetry • Bronchodilator therapy • Chest physiotherapy • Adequate nutrition, hydration, and humidification • Incentive spirometry Successful weaning from the ventilator is supplemented by intensive pulmonary care

27. Weaning From the Tube:- Weaning from the tube is considered when the patient can breathe spontaneously, maintain an adequate airway by effectively coughing up secretions, swallow, and move the jaw. If frequent suctioning is needed to clear secretions, tube weaning may be unsuccessful (Ecklund, 1999)

28. Weaning From Oxygen The patient who has been successfully weaned from the ventilator, cuff, and tube and has adequate respiratory function is then weaned from oxygen. The FiO2 is gradually reduced until thePaO2 is in the range of 70 to 100 mm Hg while the patient is breathing room air. If the PaO2 is less than 70 mm Hg on room air, supplemental oxygen is recommended. .

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