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.
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.
diveRN
135 Posts
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.