Preferred mode of ventilation and weaning

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What is your preferred mode of ventilation? We have the Dräger Evita XL, what a machine! We start out with the BiPAP+ASB mode, and as soon as the sedation is reduced enough we switch to CPAP+ASB. We have no weaning protocol and so the weaning process is rather random. Some doctors are agressive some are carefull, many nurses adjust the ventilatorsettings themselves based on experience. We have an intensivist present 24 hours.

But do any of you wean using the BiPAP+ASB mode by reducing the set resp.frequency and the Tinsp? that will allow for gradually more spontaneous ventilation.

Maybe some of you with different ventilators than the Dräger would like to tell about how you manage weaning.

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Specializes in Cardiac.

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.

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Specializes in icu/er.

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.

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Specializes in ICU/Critical Care.
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

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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!

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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.

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Specializes in ICU/Critical Care.

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.

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

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Specializes in Cardiac.

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.

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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).

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Specializes in Cardiac.

Our pulmonologist manages the vents.

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Who manages your ventilators in your facilities?

>

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.

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