Spontaneous Breathing Trial by pptfiles


									Spontaneous Breathing trial Protocol
1. Introduction: Although mechanical ventilation is a lifesaving procedure, it carries numerous life threatening complications. Therefore it is important to discontinue mechanical ventilation at the earliest possible time. Clinical decision to discontinue mechanical ventilation is often arbitrary, and relies heavily on the practitioner experience. Recent published literature has shown that daily screening of respiratory function of patients receiving mechanical ventilation, followed by spontaneous breathing trials, resulted in reduction in the duration of mechanical ventilation and lower cost of intensive care in addition to fewer complications. Therefore we propose this following spontaneous breathing trial Protocol for all adult patients receiving mechanical ventilation. 2. Collaborators: Said Soubra, MD Venkata Bandi, MD Marcia Katz, MD Harish Seethamraju, MD 3. Refereces: 1. E. Wesley Ely. Effect of the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. NEJM 1996;335:1864-9 2. Andres Esteban. A comparison of four methods of weaning patients from mechanical ventilation. NEJM 1995; 3321:345-350 3. Neil MacIntyre. Evidence Based guidelines for weaning and discontinuing ventilatory support. Chest 2001; 120:375S-395S 4. Jonathan Cohen. Automatic tube compensation-assisted respiratory rate to tidal volume ratio improves the prediction of weaning outcome. Chest 2002; 122:980 5. Yugi Fujino. Spontaneously breathing lung model comparison of work of breathing between ATC and pressure support. Respir care 2003; 48(1): 38-45 6. Andres Esteban. Extubation outcome after spontaneous breathing trials with Ttube or pressure support ventilation. Am J Respir Crit Care Med 1997; 156:459-65

Spontaneous Breathing Trial
Assessment for extubation
Check if the following criteria are met O Evidence of reversal of the underlying cause of respiratory failure O Adequate oxygenation (e.g. PaO2/FiO2 >150-200; FIO2<40-50%; PEEP<5-8) O Hemodynamic stability O Capability to initiate an inspiratory effort O Adequate mentation if above criteria are met

Ask Respiratory Therapy to Measure the Following Parameters
Maximal Inspiratory Pressure ( - 20cm H2O) Respiratory Rate (35 breaths/min) Tidal Volume ( 5 ml/kg) Rapid Shallow breathing index RR/TV ( 105) if above criteria are met

Ask Respiratory Therapy to start Spontaneous breathing Trial
Choose one of the following modalities: O T piece trial; FiO2 of ----% O Pressure Support PS ---- cm H2O(5-8 cm H2O); PEEP 5 cm H2O, FiO2 ----% O Automatic Tube Compensation 100%; FiO2 ----% Continue SBT for 30 minutes

Assessment of Tolerance
O Respiratory Rate < 35 breaths/min O SaO2 > 90% on FiO2 <0.4-0.5 O Heart Rate < 120% from baseline O Systolic Blood Pressure O Absence of respiratory distress (use of accessory muscles, abdominal paradox..) O Optional ABG criteria: Increase in PaCO2 <10 mm Hg or Decrease pH < 0.1

if above criteria are met Call MD for extubation if above criteria are not met resume previous ventilator orders and inform MD of results of SBT

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