Pilbeam's Ch 20 Weaning & Discontinuation of Mechanical Ventilation.docx

When can ventilation be discontinued? - correct answer after the need for ventilation is resolved About ____% of patients requiring temporary mechanical ventilation do not require weaning - correct answer 80% What is weaning? - correct answer gradual reduction of ventilatory support from a patient who's condition is improving Ventilatory support should be discontinued how soon to avoid risks associated with mechanical ventilation? - correct answer as soon as possible What are four factors to consider for weaning? - correct answer -patient may require PSV -supplemental O2(35%) and PEEP may be required -require an artificial airway -may require one or all of the above Extubation is ______ from discontinuation of support. - correct answer different What are three methods for titrating ventilator support during weaning? - correct answer -SIMV -PSV -T-piece weaning Respiratory muscles perform work with which breaths during SIMV? - correct answer both mandatory and spontaneous breaths What is the purpose of SIMV for weaning? - correct answer reduce pts mandatory rate at a pace that matches the patients improvement In SIMV the rate is low (less than ___ to ___ breaths/min) - correct answer less than 4 to 6 breaths/min In SIMV, reduce the rate in what increments? - correct answer 1 or 2 breaths/min What amount of PSV can be added to SIMV? - correct answer 5-10 cmH2O What amount of PEEP can be added to SIMV? - correct answer 3-5 cmH2O When weaning a patient with PSV, the patient controls what? - correct answer rate, timing, and depth of each breath In PSV, breaths are _____ triggered, _____ limited, and _____ cycled - correct answer -patient triggered -pressure limited -flow cycled In PSV, the pressure support can be set at what? - correct answer 5 to 15 cmH2O When establishing pressure support, attempt to re-establish the patients baseline rate of _____ and TV of _____ - correct answer rate: 15 to 25 breath/mins TV: 300 to 600 mL Gradually reduce the level of PSV until about what? - correct answer 5 cmH2O When weaning with PSV, monitor the patient for signs of what? - correct answer distress T-piece weaning is the _____ technique of weaning patients - correct answer oldest How is T-piece weaning assembled? - correct answer -humidified gas source connected to a T-piece with large bore tubing -then attached to ETT -another piece of large bore tubing attached to exhalation side of T-piece When T-piece is used through a ventilator, what else is used? - correct answer CPAP T-piece weaning is not tolerated well in patients with what? - correct answer -underlying heart disease -severe muscle weakness -inclined to panic -preexisting chronic lung condition What do closed loop control modes do for ventilator discontinuation? - correct answer set variable is compared with a measured variable, then vent uses a feedback signal to adjust the output Closed loop modes of ventilation range from simple techniques such as ______, to more complex ones such as ______ - correct answer -volume support -adaptive support What are the closed loop control modes for ventilator discontinuation? - correct answer -automatic tube compensation (ATC) -volume targeted pressure support ventilation -automode and variable pressure support/variable pressure control -mandatory minute ventilation (MVV) -adaptive support ventilation -artificial intelligence systems What is the automatic tube compensation (ATC) designed to do? - correct answer reduce the wob associated with increased ETT resistance automatic tube compensation targets what? - correct answer pressure at the tracheal level How do you set automatic tube compensation? - correct answer -select ATC and enter tube type -select tube size