Ventilation and Weaning

Original Editor - The Open Physio Project

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Introduction

Ventilation can be defined as the process of exchange of air between the lungs and the ambient air. In the clinical setting, a machine known as a mechanical ventilator is used to perform this function on patients faced with serious respiratory illness. Weaning is the gradual withdrawal of a patient from dependency on a life-support system or other form of therapy. 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 it is only for a trial period
• The ventilator support is gradually reduced (e.g. reducing pressure during pressure support)
• The patient is placed into a better postural position (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
• The patient is monitored 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 due to:

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

Guidelines

The following are links to documents that serves as clinical guidelines to the use of mechanical ventilator and when to commence weaning process;

1. http://www.sciencedirect.com/science/article/pii/S0012369216623243
2. https://www.health.ny.gov/diseases/communicable/influenza/pandemic/ventilators/docs/ventilator_guidelines.pdf
3. http://www.learnicu.org/Docs/Guidelines/AcuteRespiratoryFailure.pdf
4. https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0007/239740/ACI14_Man_NIV_1-2.pdf
5. http://www.northdevonhealth.nhs.uk/wp-content/uploads/2012/12/Multiprofessional-care-plan-Appendices-only.pdf
6. http://www.nejm.org/doi/full/10.1056/NEJMra1203367
7. http://neoreviews.aappublications.org/content/18/7/e413?utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=NeoRev_TrendMD_1