Mechanical ventilation weaning to extubation protocols?

[begalli]

I have a question for the group.

Patient's always come to us from the OR on 100% Fi02, a rate, a tidal volume tailored to them, ps 10, peep 5. When we wean patient's from the vent on our CT unit, the final settings on the vent just prior to extubation are usually 35-40% Fi02, pressure support of 10, and PEEP of 5.

When I recently had a relative in the hospital for a major surgery, the vent settings for him for quite a period of time before extubation included Fi02 only, no ps, no peep. His ETT was a size 9!! I've never seen a tube that big!

I'm just wondering what others do? Is peep routinely used in your setting? What about pressure support? Or what does your weaning protocol look like?

:)

[heartICU]

I have a question for the group.

Patient's always come to us from the OR on 100% Fi02, a rate, a tidal volume tailored to them, ps 10, peep 5. When we wean patient's from the vent on our CT unit, the final settings on the vent just prior to extubation are usually 35-40% Fi02, pressure support of 10, and PEEP of 5.

When I recently had a relative in the hospital for a major surgery, the vent settings for him for quite a period of time before extubation included Fi02 only, no ps, no peep. His ETT was a size 9!! I've never seen a tube that big!

I'm just wondering what others do? Is peep routinely used in your setting? What about pressure support? Or what does your weaning protocol look like?

:)

Our patients would come from the OR on 100%, a rate, appropriate tidal volume, and usually 10 PEEP and 10 PS. Our final parameters were 40%, CPAP, PEEP 5, PS 5.

What was your family member's surgery?

[begalli]

Thanks heartCIU

It was an open AAA repair. I've just never seen such a huge tube before and I was actually kind of curious about no support other than 02 with the vent.

He was a smoker. I'm wondering if they thought that having the extra thoracic pressure of the peep in there with his already more than likely less-than-compliant lungs would make it hard to get him extubated.

I asked the RT and she said that all of their patients end up on just the Fi02 just prior to extubation. But no pressure support? I would think that it would AWFULLY hard to breathe and oxygenate through that tube without some support...like breathing through a straw.

[eb0lagirl]

After surgery, our patients come up on similar settings (IMV, 100% FIO2, PEEP, PS, delta P). We then wean the FIO2 and may change the rate, based on the ABGs or end tidal CO2. Then, the pt is placed on pressure support mode (with FIO2 support usually between 30-40%). If they tolerate that for an hour or so, the RT will check the NIF and the tidal volumes, x-ray will be checked - if all these things look good, then we extubate.

[zambezi, BSN, RN]

OUr patient's also come up on simv, rate 10, fio2 100%, peep 5, psv 12. After the first abg on admit, we usually wean down at least to fio2 of 40% (as patient tolerates, of course). If patient still sats well on 40 then we go to 30% but we can initiate weaning on 40%. The other parameters don't really change unless they need to (which we do on our own in conjunction with the RT--unless the gas is really out of whack). When we are ready to wean we drop to a rate of 5 then to cpap with psv of 5. Along with some other criteria if patient is doing well and abg's ok we extubate.