Spontaneous Awakening & Breathing Protocols?

Specialties MICU

Published

Specializes in Critical care.

Does anyone have protocols/order sets for Spontaneous Awakening and Spontaneous Breathing Trials that they would be willing to share? Our system has a committee that has been working on developing these protocols. Unfortunately, the protocols seem to get progressively worse with each revision : ) Any suggestions would be appreciated.

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No real protocol for nursing per se, we just know everyone that meets some basic criteria (FiO2

Our RT's are usually good and don't make patients suffer unnecessarily and will stand around and get an RSBI before wandering off to trial someone else. If everyone goes by the book, most people don't stay on CPAP any longer than the RT is in the room if they appear they won't do well.

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I wouldn't include vasopressor use as an exclusionary criteria. Patients may be on stable supportive doses of pressors and inotropes and be excellent candidates for extubation. Actively titrating gtts for HF/sepsis etc is another issue....but I extubate pts daily on epi/phenyl/milrinone etc.....

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RT has their own protocols to go by, and vasopressors means no weaning trial according to them. Not saying I agree, that's just how it goes for us.

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RSBIs in our hospital usually depend on the RT. My preference is to try someone on PSV 0/PEEP 5, for 2 mins. I usually do this on anyone on PSV of 12 or less. An RSBI of 100 or less is usually a sign that someone can be extubated, as long as they are relativly stable as mentioned above.

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Specializes in ICU, ER, EP,.

I'm looking for the policy,

Must be afebrile

FI02 is at less than 60% and peep 7 or lower

PH with in patient norms

All sedation is shut off at 2am, and cpap is started, by 6am an abg is drawn, if patient is awake, able to follow directions and ABG looks good we extubate.

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