Ventilation and Weaning

Original Editor - The Open Physio Project

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Introduction

Weaning a patient from a Ventilator occurs when the condition of the patient improves and a decision is made to remove them from the ventilator through a trial of spontaneous breathing through the endotracheal tube and eventually extubation (removal of the tube).

Procedure

The procedure is as follows:

• Explanation of the procedure to the patient, assuring them that it is only for a trial period.
• The ventilator support is gradually reduced (e.g. reducing pressure during pressure support).
• Choose a better posture for the patient (e.g. sitting upright or half-sitting).
• The airway is suctioned.
• The patient is disconnected from the ventilator and given oxygen or mechanical assistance (CPAP).
• The patient is encouraged to breathe spontaneously.
• Look for signs of laboured breathing, anxiety or an increase in PaCO₂.
• Extubation should occur as soon as possible because breathing through an endotracheal tube increases the Work of breathing.
• Encourage the patient to cough after being extubated.
  

Patients may be extubated when they are alert, show a stable breathing pattern and control their airway. Difficulties in weaning patients from a ventilator can occur because of:

• Inspiratory muscle atrophy
• Fatigue
• Paralysis of the diaphragm
• A fear of suffocating