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1. Samantha Chanel De Vera Posted Date Apr 7, 2022, 6:24
Samantha Chanel De VeraPosted DateApr 7, 2022, 6:24 AM(edited)UnreadReplies to
Maresah HarrisWeaning from mechanical ventilation should be considered when the
disease process prompting intubation has improved. Daily screening of intubated patients
for weaning potential should be performed. Several studies show that most patients on
mechanical ventilation should have scheduled spontaneous breathing trials (SBT) following
daily sedation breaks(Zakhary & Uppal, 2017). Aside from the improvement of the primary
etiology of the disease process, the patient should be alert, following commands, initiating
breaths, able to hold their head up, able to cough with the recent PaO2 ≥ 60 with FiO2 ≤
40% and PEEP ≤ 8 and needs suctioning ≤ every 4 hours, and hemodynamically stable with
minimal pressor support before considering extubation(Zakhary & Uppal, 2017). Daily SBT
should involve at least 30-120 mins of breathing without significant ventilatory support,
specifically the use of either an open T-piece breathing system or minimal amounts of
ventilatory support such as pressure support to overcome the resistance of the ETT or low
levels of CPAP(Jameson et al., 2020). However, the patient must initiate all breaths and
control tidal volume. A successful SBT is where the patient continues to breathe without
distress with stable vital signs and a stable arterial or ETCO2 tension. Tachypnea,
hypoxemia, tachycardia, bradycardia, hypotension, hypertension, increased anxiety, or
diaphoresis are some indications of SBT failure(Jameson et al., 2020). Other risks during the
weaning process are unplanned extubation, especially when the patient becomes suddenly
very restless and agitated and develops dysrhythmias. If the SBT is successful, rapid shallow
breathing index (RSBI) or f/VT, calculated as a respiratory rate per min divided by the TV in
liters, should be done at the end of SBT, which can be used to predict weanability. An RSBI
of <105 at the end of SBT warrants an extubation trial(Jameson et al., 2020). Despite a
thorough weaning trial, patients may still develop respiratory distress after extubation and
may require a reintubation.ReferencesJameson, J. L., Fauci, A. S., Kasper, D. L., Hauser, S. L.,
Longo, D. L., & Loscalzo, J. (2020). Respiratory failure. In Harrison’s Manual of
Medicine (20th ed., pp. 75–76). McGraw Hill.Zakhary, B., & Uppal, A. (2017). Mechanical
Ventilation. In S. C. McKean, J. J. Ross, D. D. Dressler, & D. B. Scheurer (Eds.), Principles and
practice of hospital medicine (2nd ed., pp. 2524–2541). McGraw-Hill.REPLY