Medical Directive to Wean Patient Rapid

Anticipated Wean

YES

Total Respiratory Rate > The

Set Respiratory Rate And
Patient RASS +2 to -2
YES

NO
Set Resp Rate By 2 Breaths
Every 30 Mins Until 8 BPM.
Wean Sedation to a RASS of +2
to -2

Wean Fi O2 to Maintain Sa O2 95%

Wean Fi O2 0,4 switch to PS Mode
Signs of Fatigue

NO

PS by 2 cm every
10 mins untill off
YES

Increase PS to pre wean

level

Signs of Fatigue

NO

Call Doctor to Review

PEEP by 2cm every 10 mins

until =5
Continue on CPAP 5 cm for
10 mins
Signs of Fatigue
NO
NO

Does patient meet

extubation criteria

YES

Extubate as per
extubation NPS

ENROLLMENT CRITERIA
No vent discontinuation failure within
past 24 hrs
Pa O2 /Fi O2 25 cc/cm H2O
Minute volume 15L/min

Immediate SBT :
Ventilated 72 hrs
Hrs?

NO

YES
SBT CRITERIA
GCS 10 or
tracheostomy
MAP 60mmHg, no
pressors
YESwithout pain
Good cough
NO

Place pt on IMV
At prioe rate with
PS to keep VT 5 ml/kg

OXYGEN / VENTILATION WEANING

Maintain Sa O2 92%
Decrease Fi O2 incrementally to 0,50
Decrease PEEP incrementally to 8
cm H2O
Maintain spontaneous RR 30 and VT 5
ml/kg; no IMV or PS changes if respiratory
drive abnormal
Decrease IMV rate incrementally to
6 bpm
Decrease PS incrementally to 8 cm
H2O
Tolerates incremental
change ?
YES

SBT
Assess for 30 mins
tolerated ?
YES

NO

NO

Next SBT in
6 Hours

NO YES
Return to prior
settings Notify
MD failed 2
SBTs Today

Time
07.0019.00 hrs
& Meets
SBT
Criteria?
NO
YES

Reverse
most recent
change
improveed
within 10
mins
NO

YES

Notify
MD
Go to
SBT
Obtain ABG and notify MD for extubation

ScvO2
Balance of O2 delivery &
consumption
Oxygen
Delivery

Hemoglobin

Hemoglobin
Occult
Bleeding
Anemia
Hemodilution

Preload
CVP

Oxygen
Consumptio
n

Oxygenati
on

Cardiac
Output

FiO2
Ventilatio
n
Stroke
Volum
e

Heart
Rate

Afterload
SVR
PVR

Contractili
ty SWI

Metabolic
Demands
Fever
Pain
Agitation
Stress/anxiet
y
Suctioning
Shivering
Trauma
MODS
Sepsis
Burns

Four Components That Effect

ScvO2
Vasoactive Meds
Dysrhythmia
Congestive Heart
Failure
Cardiac Surgery
Arrest

HgB

C.O

Hemorrage
Occult Bleeding
RBC Disorders
Anemia
Hemodilution

ScvO2
Hypoxia/Hypoxemia
Suctioning,atelecta
sis
Ventilation/oxygena
tion
Lung Disesase
Shunting

SaO
22

VO2
VO2

Sepsis
Work of breathing
Fever, shivering
Trauma
Pain/anxiety