The art of weaning kuwait

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The art of weaning kuwait

  1. 1. The Art of Weaning An Ordered Approach Dr. A. Gursahaney MD, FRCPC Associate Chief Department of Critical Care McGill University Health Center Associate Professor of Medicine McGill UniversityMcGill University Health Centre
  2. 2. The Art Of Weaning• Supply versus Demand• Respiratory Capacity versus Ventilatory Loads• Systematic Approach – Why are they failing? McGill University Health Centre
  3. 3. McGill University Health Centre
  4. 4. RESPIRATORY CAPACITY• DEPRESSED DRIVE Narcotics, Sedative Drugs Metabolic Alkalosis Hypothyroidism McGill University Health Centre
  5. 5. RESPIRATORY CAPACITY IMPAIRED TRANSMISSION• Spinal Cord Disease Multiple Sclerosis Amyotrophic Lateral Sclerosis Trauma• Phrenic Nerve Injury Cardiac Surgery Trauma Post Viral Illness Post Central Venous Catheterization• Peripheral Neuropathy Guillain-Barre ICU Polyneuropathy• Neuromuscular Junction Myasthenia Gravis McGill University Health Centre
  6. 6. RESPIRATORY CAPACITY• MUSCLE WEAKNESS Steroid Myopathy Malnutrition Electrolyte Imbalance Endocrinopathies McGill University Health Centre
  7. 7. VENTILATORY LOADS• INCREASED CENTRAL DRIVE Sepsis Fever Anxiety, Pain, Agitation Increased CO2 Production McGill University Health Centre
  8. 8. VENTILATORY LOADS• INCREASED DEAD SPACE VENTILATION Pulmonary Embolism ARDS COPD McGill University Health Centre
  9. 9. VENTILATORY LOADS• RESISTIVE LOADS Bronchospasm Secretions Endotracheal Tube Ventilator Circuit• LUNG ELASTIC LOADS Pulmonary Edema Pneumonia Atelectasis• CHEST WALL ELASTIC LOAD Pleural Fluid Abdominal Distension Ascites Obesity McGill University Health Centre
  10. 10. VENTILATORY LOADS• THRESHOLD LOADS Ventilator Trigger Intrinsic PEEP McGill University Health Centre
  11. 11. McGill University Health Centre
  12. 12. Weaning Success• Mental status, protect airway• Secretion management• Gravity is your friend• Sleep Wake Cycles McGill University Health Centre
  13. 13. Extubation Success• Oxygenation – PO2 > mmHg on FiO2 < 35% – PO2/FiO2 >200mmHg – PEEP < cmH2O• Breathing pattern – spontaneous breathing – Ƒ<30 breaths/min – Vt > 5ml/kg – VE < 10 l/min – VC >10 ml/kg• Neuromuscular capacity/drive – PI max < - 20cmH2O – P 0-1 < 5.5cmH2O• Integrative indices – Ƒ/t < 105 McGill University Health Centre

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