summer 06 final patho
Terms
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- STAYING OFF THE VENT
- requires a balance between the imposed work of breathing and the ability of the patient to do that work
- airways tumors or clogged ven filters
- increase RAW
- factors to be considered when someone comes off the vent
-
1) underlying process reveresed
2)hemodynamically stable
3)adequate cough
4)maintain the airway
5)adeqaute respiratory drive
6) - alkalemia
- tends to depress the respiratory drive
- weaning parameters
-
1) MV 4-6 liters
2)RR BETWEEN 8 and 30
3)tv >325 cc
4)NIF -20 - VC requirement for weaning
- 1) VC at least 10-15 cc's
- PaO2, FiO2, PEEP requirements for weaning
-
1) less than 60 mm Hg
2)FiO2 less than 50
3) PEEP less than 8 - checklist for extubation
-
1)oxygenation
2)LOC
3)hemodynamics
4)MV, RR,TV,VITALs
5)Tobin index less than 105 - typical weaning techniques
-
1)A/C with increased breathing
2)SIMV decreasing rate
3)SIMV, decreased R, decreased PS
4)CPAP and PS, decreased PS
5)CPAP only
6)extubation to NIV - ideal pace for spontaneous breathing trials
- 30-120 minutes
- Signs that a patient has passed t-piece weaning
-
1)SpO2>88, sat above 55
2)ph >7.32, increase in PCO2 less than 10
3)HR less than 20, less than 20 BPM increase, BP 90/180, with less than a 20 percent change - Signs that a pt. has failed
-
1)change in LOC
2)diaphoresis
3)increased WOB
4)ischemia