Given the criteria for weaning from Mechanical ventilation

1. DEPARTMENTOF CARDIOVASCULAR AND
RESPIRATORY SCIENCES

2. Weaning of the Patient from
Mechanical Ventilation
Dr. SHIRIL NAGARKAR
Professor & HOD
DEPARTMENT OF CARDIOVASCULAR AND
RESPIRATORY SCIENCES

3. Purpose Statement
 At the end of the class the students should be
able to know all criteria's to wean a patient
from Ventilator

4. Learning Objectives
Sr.
no
Learning objectives domain level criteria condition
1 Define Weaning Cognitive Must know All
2 Explain Weaning
Criteria
Cognitive &
Psychomotor
Must know all
3 Explain Different
Conditions to wean
Cognitive &
Psychomotor
Must know all
4 Explain role of
Physiotherapist in
Weaning
Cognitive &
Psychomotor
Desired to
know
All

5. Definition of Weaning
The transition process from
total ventilatory support
to spontaneous breathing.
This period may take many forms ranging from abrupt
withdrawal to gradual withdrawal from ventilatory support.

6. • Once the problem or the condition caused the
need for Mechanical Ventilation is resolved,
most patients can be quickly & easily
removed from the ventilator

7. • 80% of the patients do not require slow withdrawal
process & can be discontinued within few hours or days
• Eg:
• 1) Post operative Ventilatory support
• 2) Treatment of the uncomplicated drug overdose
• 3) Exacerbation of asthma

8. Timing
• Carefully timed
• Premature : stress the cardiopulmonary
system & delays the patients recovery
• Reintubation

9. • Delay : causes, increased risk of complications
– Nosocomial pneumonia
– Myocardial infarction
– Weakness or wasting of inspiratory
muscles
– Death

10. Methods of Weaning
1. Increasing periods of spontaneous breathing
(often with T-tube) altering with mechanical
ventilation.
2. S.I.M.V
3. Pressure Support
4. Single daily spontaneous breathing trail (SBT)

11. Patient Evaluation
1. Important factor to consider in this assessment is the
length of time the patient has been receiving
mechanical ventilation
• < 72 hrs : can be removed quickly
• Longer period : needs structural approach

12. Condition is improving or not i.e the
condition which has lead to the Mechanical
Ventilation has reversed or not

13. Oxygenation criteria
• Pao2 without PEEP > 60 mmHg at 40% Fio2
• Pao2 with PEEP > 100 mmHg at 40% Fio2
• Sao2 > 90% at 40% Fio2
• Pao2/Fio2 > 200 mmHg
• PH of 7.25 or greater

14. Hemodynamic status
• Patient should be hemodynamically stable
• Absence of acute myocardial ischemia
• Marked hypotension, patient should have adequate blood
pressure without vasopressor therapy or only on a low
dose (<5 mg / kg of dobutamine )

15. Inspiratory Effort
• Patient should be able to take a spontaneous
breath if the Mechanical Ventilation is
discontinued.

16. Ventilatory Criteria
• Increased thoracic cage movement during
spontaneous breathing
• Asynchronous chest wall to diaphragm movement
• Tachypnea ( > 30/min )

17. • Rapid shallow breathing
• Use of accessory muscles
• Inability to alter ventilatory pattern on
command

18. • Patient with non of these signs have 90%
chance of success
• Patient with one or two of these signs usually
need continued support

19. WEANING PROCEDURE
• T- tube trials
• SIMV
• Pressure support
• S.B.T

20. • Traditionally, physicians have approached the
discontinuation of MV through a gradual reduction in
ventilatory support, which is reflected in universally
applied but varying forms of “weaning.”
• However, this gradual approach may unnecessarily
delay the extubation of patients who have recovered
from respiratory failure.

21. Spontaneous Breathing
Trail
• Shortly after patients demonstrate that their
condition has been stabilized on the ventilator,
a spontaneous breathing trial (SBT) is safe to
perform and is indicated.

22. • SBTs can be performed safely by non-physician HCPs
using a T-piece, continuous positive airway pressure
without pressure support, or with pressure support up to
7 cm H2O, and for durations of 30 min to 2 h.

23. • The monitored assessment of spontaneous breathing should
be conducted at least once daily (with the head of the bed
elevated and after notifying the patient of the start of the SBT)
and should be integrated with other major events in the
patient’s daily care, including the cessation or temporary
reduction in delivery of sedation and analgesia medications.

24. When SBT Is Failed ?
 All remediable factors should be addressed to enhance the
prospects of successful liberation from MV (eg, electrolyte
derangements, bronchospasm, malnutrition, patient positioning,
or excess secretions)
 The patient should be placed in an upright position on a
comfortable, safe, and well-monitored mode of MV (such as
pressure support ventilation).

25. • An SBT should be performed at least once daily.
• In the face of repeated failures at daily SBTs, clinicians
should consider longer-term options, including both
tracheotomy and a long-term acute-care or stepdown
ventilator facility.

26. • Patients have passed an SBT, clinicians
seriously consider prompt extubation.

27. Summary
 Definition of Weaning
 Different Criteria's of Weaning
 Hemodynamic Status

28. Questions
 Definition of Weaning
 Discuss the different Criteria's of Weaning
 Explain Hemodynamic Status with reference
to Weaning

29. Bibliography
 David Chang: Textbook on Mechanical
Ventilation

30. Thank you