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Protocol
PATIENT FACTORS
□ Hemodynamically stabilizing:
□ Vital signs acceptable ( BP ≥ 90 systolic, HR ≈ 55 to 135 bpm)
□ Tapering/low doses of vasopressors
□ Sp02 > 92%
□ Can follow simple commands
□ Adequate cough on command
□ Initiate good inspiratory effort
□ Patient is not expected to follow commands
VENTILATOR PARAMETERS
□ FiO2 < 50%
□ PEEP ≤ 5 cm H20
ABG PARAMETERS
□ PaO2 ≥ 75 mmHg
□ pH > 7.25
STEP 2: Criteria met, Notify Physician for
initiation of protocol
RN and RT communicate the weaning readiness with
the MD/DO ( fellow/housestaff/attending)
Physician decides whether weaning should be
initiated. Some situations in which the patient meets
criteria but weaning will not be done include –
procedure or test that will require ventilation,
concerning lab test or change in stability.
Physician decides on the vent weaning mode,
completes orders and places order in Prism to
initiate weaning protocol
Feedings held
Sedation goal RASS of 0 achieved or hold sedation
Explain to the patient
Physician Order for Weaning
The MD/NP needs to place the order for
weaning only once
This order will remain active for daily
weaning unless cancelled due to change in
patient condition
Please note…
There are some patients who have a
neurologic injury or baseline dysfunction
– who are not expected to follow
commands, but who still may be able to
wean from the ventilator.
The clinicians may decide to proceed with
a trial of weaning in patients who do not
pass all readiness criteria.
Start weaning protocol early
Between 5:30 and 7 am in the ICUs
By 9 am for chronically-ventilated patients
in the stepdown units
STEP 3: Method of weaning
chosen by physician
SPONTANEOUS SIMV METHOD
PRESSURE
□ Set IMV___ PS___
BREATHING SUPPORT SICU METHOD
□ FiO2___%
TRIAL METHOD VENTILATION
□ Decrease IMV rate by □ CPAP = 5, PS=0
(SBT) METHOD (PSV)
__ q __ h □ FI02 21%
□ PS=____ □ Set PS___
□ Decrease PS by ___ □ Tolerates 20 min
□ CPAP = ___ □ FiO2___ %
q ___ h □ Then ABG:
□ FI02 ___% □ Decrease PS by
□ ABG needed ( ) Y ( ) GOAL:
□ T-piece ___q ___h
N Pa02 >50mmHg
□ Duration ___minutes □ ABG ( ) Y ( ) N PaC02 <50 mmHg
□ ABG needed ( )Y( ) N GOAL : PS ≤ 5 for
GOAL: IMV ≤ 4 AND RR < 35/min
GOAL : ____ min ____ min
PS ≤ 8 for ___min
Acute weaning – Spontaneous Breathing
Trial “SBT”
The most common method is the SBT: CPAP
mode, pressure support 5-8 cm H20. Duration
30-120 minutes.
Other methods include:
◦ SIMV with gradual reduction in respiratory rate
◦ Pressure support with gradual reduction in amount
of pressure support
For SICU patients, CPAP trial for 20 min
Physician Order: must complete method,
settings, and duration
STEP 4: Assessing patient tolerance of weaning