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Saturday, October 27, 2007

Considerations for readiness to wean

Here are some things to consider when determining if an intubated patient is ready for a weaning trial.

1. Awake and alert

2. Able to follow commands

3. Spontaneously breathing

4. Adequate cough

5. Pain controlled

6. No obvious signs of respiratory distress

7. Little to no anxiety

8. FiO2 equal or less than 40

9. PEEP 5 or less

10. Temperature equal to or less than 100.4

11. Hemodynamically stable

  • No Dopamine infusion greater than 5 mc/kg
  • Systolic BP
  • Pulse >50
12. ABGs normal for patient

13. A-a gradient less than 300

14. a-A ratio greater than 50%

15. PaO2/FiO2 greater than 150-200

16. Underlying condition resolved

17. Chest X-Ray improving

18. Adequately nourished (Albumin >2.5)

19. Electrolytes stable (CA, Mg, K)

20. Secretions thin and minimal

21. Adequate Hemoglobin (>8-10)

22. Adequate Hematocrit (>25% or baseline)

23. Absence of bowel problems (diarrhea, constipation, ileus)?

24. Weaning parameters within normal limits:

  • NIF greater than 20
  • VC >10ml/kg IBW (2*VT)
  • VE less than 10- 5ml/kg IBW
  • VC double VT
  • RR less than thirty 30
  • RSBI (VT/RR) less than 100

25. PS must be at patients weaning level:

  • PS = Static minus PEEP
  • Normal PS usually at least<=10
26. P0.1 = or less than 4.2.

27.   P0.1 > 4.2 is "associated with failure to become liberated from the ventilator... If under 4.2, weaning was successful 78% of the time."  (reference is Vent world)


Djanvk said...

Wow huge list, but a good one I learned some things, especially what PO.1 was, never heard of it or did I notice it on a Servo I, unfortunatyly I'm not working with them anymore so I can't go look. I had a heart doc once who did his weaning by seeing if the patient could raise his/her head off the pillow, if they could, good to go seemed to work.

David said...

We use a Dräger Evita 2 at the hospital I work at, and have been using PO.1 for quite some time now. It IS an excellent measure of weanability and extubatability. I am glad you decided to include it on this list.

So long as everyone remembers that one good parameter does not a successful extubation make.

If multiple parameters you use, successful extubations you will have.