Question

Identify 15 patient factors that impacted the ability of the patient to wean from the ventilator. Explain
how the factors impact.

Answer 1

Ans.

Discontinuation of mechanical ventilation is a two-step process, consisting of readiness testing and weaning: ... Weaning – Weaning is the process of decreasing the amount of support that the patient receives from the mechanical ventilator, so the patient assumes a greater proportion of the ventilatory effort.

​​​​​​Factor that impacted the ability of the patient to wean from the ventilator--

Of the 6 studies reviewed, all identified various predictors of weaning outcome, which included

•maximal inspiratory pressure

•rapid shallow breathing index

•fluid balance

•comorbidity burden

•Severity of illness

•emphysematous changes

•low serum albumin.

Weaning can also be carried out by a process of progressive withdrawal in which ventilatory support is gradually withdrawn. For example, the level of pressure support may be decreased by 2-4 cm H2O per day as long as the patient does not show signs of intolerance. Conversely, daily T-piece trials of systematically increasing duration can be used.

Key management points

• Return the patient to full ventilatory support.

• Treat reversible pathophysiologic causes of weaning failure.

• Consider using a weaning protocol to standardize the weaning process.

• Consider daily SBTs.

• Consider systematic reduction in ventilatory support using pressure support ventilation.

• In appropriate patients, consider using non-invasive ventilation as a weaning technique.