Pulmonary Medicine-Vent ISSN 1930-6741
Ramesh Kaul ,MD, MS, FCCP
1. Rest patient on full support various modes including PRVC, AC, SIMV and wean
thrice a day on Pressure Support, Volume Support or SIMV with low rate.
2. Increase the duration of time until each session blends with the next one.
3.Give spontaneous breathing trials each session until patient shows signs of fatigue.
4.Start tracheal mask trials or tracheal T tube trials and increase duration each day.
5.Check patient arterial blood gas analysis and chemistries periodically.
6. Avoid too much beta-agonists as they cause anxiety and tachycardia.
7.Use small tidal volumes on assist, PRVC and SIMV modes.
8.Do daily lung functions on the ventilator, check peak , plateau pressures and chest X-rays when in doubt.
9. Bed side Bronchoscopy should be done frequently when elevated pressures, change in sputum color or increase in quantity.
10. Tracheotomy patients should have adequate length tracheotomy tubes, large diameter soft cuffs and proper position to do good ventilation and weaning.
11.Do ABG as each step is reached, if changing from Assist Control to SIMV do ABG and then at each step calculate work of breathing and document effects on every system. Thus show good blood pressure and arrhythmia control. document improvement in skin and integuments. Nourishment and absence of Ileus and diarrhea. Mention mentation and improved cognition and better muscle control.
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