Preferred mode of ventilation and weaning

We put our pts on Sedation vacation, and go straight to CPAP if it's feasible.

Watch for 30min-1hr, draw an abg, and go from there. We do this every morning if the pt can tolerate it until extubation.

cardiacrn2006 is pretty close to what we do as far as vent weaning is concerned. wake'em up, stimulate, abg's, cpap, and watch vs and get set of abg's in about hr or so. sometimes the patient will make it to the point of reducing some pressures "ps" or fio2 or they'll start to tire out and we'll plug'em back into the vent and rest them. we are lucky to have a rt that has spent some time at a long term vent mangt. center and he is very skilled on getting folks off the vent.

We put our pts on Sedation vacation, and go straight to CPAP if it's feasible.

Watch for 30min-1hr, draw an abg, and go from there. We do this every morning if the pt can tolerate it until extubation.

Thats exactly what we do. I haven't seen a lot of SIMV. It's either assist-control or CPAP

In theory, weaning should begin the instant a pt is intubated. We all know that theory is not reality. Vital capacity, NIF, RSBI, Gases, leak test, CPAP trial (Pressure Support) can all be used to asses a pt's ability to spontaneously ventilate. Obviously extubating a 23y/o OD will be different than a TBI pt. I guess my point is while a weaning protocol is nice for documentation purporses, each pt can be a different experience. Personally, I like to document Vc, RSBI, ABG after and hour on CPAP (Pressure Support) if tollerated, then if they are alert and ready, yank it!

I feel weaning should be indifferent to the vent. We use Drager as well, Evita 2 dura and the Savina, you're right about Drager being a great vent!

Thats exactly what we do. I haven't seen a lot of SIMV. It's either assist-control or CPAP

No SIMV? When I worked at a large metro hospital, all we used was AC/CPAP modes. Now I work in a small rural ICU, with no intensivist/pulmonologist, where we are quite progressive (compared to the last place anyway) and don't ever use A/C. I was pleasantly surprised when I relocated.

No simv so far. At my last job, I had a lot of vent patients that were on SIMV. But at my current job, AC/CPAP is all I've seen.

We almost exclusively use SIMV. We wean FIO2, Rate, PEEP, and PS as tolerated and based on ABGs. SIMV-->CPAP->40% AFM.

SIMV is actually rare for us. Sometimes I've seen it used but with a rate so high that it's no different from AC, like SIMV with a rate of 16-but with the pt never overbreathing the vent.

I find it very interesting to see the different vent. modalities that are used by various institutions. Who manages your ventilators in your facilities? Pulmonology, Anesthesia (Critical Care), Admitting, etc? Our trauma docs manage our vents (Surgical Critical Care fellowship trained).

Our pulmonologist manages the vents.

Who manages your ventilators in your facilities?

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The order usually reads "vent settings as per RT"

and "wean to extubate as per RT" a few of the docs will leave blood gas parameters.

We also use the Drager Evita XL, they are managed by RTs unless a pulmonologist is on board and wants to manage, but that's rare. We use SIMV almost always for Norc'd / sedated patients. Sometimes MMV in other situations... AC is really rare.

Wean to Extubate orders follow a hospital protocol that includes Vc, RSBI, sats, RR, sometimes ABGs, and the patients ability to lift their head off the pillow. If they meet weaning params, we move to CPAP. If they can tolerate that, then the tube comes out. RTs usually extubate, but I've done it a few times.