Question

How do we ween someone off of oxygen on a ventilator that's on a really high Fi02 and maybe a high PEEP, which one do we do first and which one do we do second and what is the process?

Answer 1

-Weaning of mechanical ventilator is gradual removal of ventilation

-To ween someone off of oxygen on a ventilator that's on a really high Fi02 and maybe a high PEEP , first we ween FiO2 and second we ween PEEP.

-Process of weaning :

​​​​​​​​​​​​​​ -Assessment for weaning ,we have to note that for weaning process, Arterial blood gases show adequate ventilation and oxygenation ,Good Respiratory rate, Good pulmonary function, Regular pulse and Blood Pressure, to see if underlying disease treated

-Decrease Ventilator settings gradually , First Systemic Intermittent Mandatory Ventilation(SIMV) rate should be decreased to 12 to 4  breaths per minute for every 4hrs, Second decreasing the FiO2 setting to a level below 60%(0.4),Third PEEP levels are reduced 2 - 5 cm HzO at a time.Speed of mandatory breathing reduction depends on the patient's tolerance.

-Methods of weaning -

1-SIMV method-decreasing the ventilator rate and allowing the patient to breathe spontaneously.  

2-T piece or Trial and error method, here patient ventilator is removed completely

3-Pressure Support Ventilation (PSV) - to support inspiration when the patient is having difficulty with weaning and provides continuous minimum pressure support

4-continuous positive airway pressure (CPAP) method-it considers parameters such as TV, RR and useful in atelectasis and hypoxemia patients

-With the above methods,if patient is showing tolerance and follows the criteria of weaning then extubation can be done (Remove intubation) with precautions

-Assessment of patient during weaning, one must notice heart and lung, any abnormal changes recorded then ventilation must be restored, patient must be alert and conscious ,patient must be treated or reassured for anxiety,confusion,lack of consciousness ,Under continous observation for any signs and symptoms .

-Preacuations -adequate assistancy is required, drugs suppressing ventilation should be stopped, weaning is done during day and make patient to rest at nights, make sure patient is alert, Re-intubation equipment must be prepared.