TECHNICAL UNIVERSITY OF MOMBASA

MEDICAL ENGINEERING

ECL 4202 THERAPEUTIC TECHNOLOGY

ASSIGNMENT QUESTION 2

1. WANJIRU GERALD KAMOTHO BSMD/349J/2022

2. EUSTUS KARIUKI MWAI BSMD/350J/2022
3. GLADYS MUTUSE MINOO BSMD/358J/2022
4. DENNIS KARANI NJOROGE BSMD/352J/2022
5. ALJANOUS MANI BSMD/353J/2022
LECTURE JOEL SABORE
26/03/2024
ACADEMIC YEAR 2023/2024

This is Therapeutic assignment

Here we will describe consideration and method of weaning and discontinuation from mechanical
ventilators.

1. Weaning Process:

o Definition: Weaning refers to gradually reducing ventilatory support to assess the

patient’s ability to breathe spontaneously.

o Indications for Weaning:

 Improvement in the underlying condition (e.g., resolving pneumonia, reduced

inflammation).

 Hemodynamic stability.

 Adequate oxygenation and ventilation.

 Mental alertness and cooperation.

o Factors Influencing Weaning Success:

 Respiratory Factors:

 Adequate lung function.

 Minimal secretions.

 Tolerance to spontaneous breathing.

  Cardiovascular Factors:

 Stable hemodynamics.

 Adequate cardiac output.

 Metabolic Factors:

 Normal acid-base balance.

 Adequate nutrition.

 Neuromuscular Factors:

 Sufficient strength to breathe.

 No neuromuscular weakness.

o Weaning Techniques:

 Spontaneous Breathing Trials (SBTs):

 T-piece trial or pressure support ventilation (PSV).

 Assess patient tolerance and readiness.

 Gradual Reduction in Ventilator Support:

 Decrease pressure support or positive end-expiratory pressure (PEEP)

gradually.

 Monitor patient response.

 Daily Assessment:

 Evaluate readiness for weaning every day.

 Consider sedation holidays.

o Weaning Protocols:

 Evidence-based protocols improve outcomes.

 Individualize based on patient condition.

 Regular assessment and adjustment.

o Extubation Criteria:

 Adequate gas exchange.

  Hemodynamic stability.

 Alert and cooperative.

 Strong cough reflex.

 Minimal secretions.

 Ability to protect airway.

2. Discontinuation Process:

o Definition: Discontinuation involves removing the endotracheal tube and transitioning

to spontaneous breathing.

o Considerations:

 Timing: Avoid premature extubation.

 Patient Factors:

 Evaluate underlying disease severity.

 Assess overall prognosis.

 Ventilator Factors:

 Optimize settings (e.g., PEEP, FiO2).

 Ensure proper functioning.

 Weaning Success Predictors:

 Successful SBT.

 Rapid shallow breathing index (RSBI) < 105.

 Negative fluid balance.

 Normal pH and PaCO2.

o Methods:

 Extubation:

 Remove endotracheal tube.

 Monitor closely for respiratory distress.

 Tracheostomy Decannulation:
  For patients with prolonged mechanical ventilation.

 Gradual reduction in tracheostomy tube size.

 Assess readiness for decannulation.

 Noninvasive Ventilation (NIV):

 Transition to NIV (e.g., BiPAP) if extubation fails.

 Provides respiratory support without intubation.

 High-Flow Nasal Cannula (HFNC):

 Delivers humidified oxygen at high flow rates.

 May prevent reintubation.

 Weaning Success Criteria:

 Stable respiratory rate and effort.

 Adequate oxygenation.

 No signs of distress.

 Tolerating oral intake.

Individual patient factors and clinical judgment play a significant role in the weaning and discontinuation
process. Close monitoring and timely adjustments are essential for successful outcomes.

REFERENCES

 Jamanetwork.com
 Litfl.com.