Ventilation can be defined as the process of exchange of air between the lungs and the ambient air[1]. In the clinical setting, a machine known as a mechanical ventilator is used to perform this function on patients faced with serious respiratory illness. Once a patient is stable and in a position to move towards spontaneous breathing it is important that that steps are taken to wean the patient of the dependency of supported breathing. Weaning is the gradual withdrawal of a patient from assisted breathing on a life-support system or other form of therapy[1]. 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). Show
Goals of Mechanical Ventilation[edit | edit source]The goals of mechanical ventilation are to[2]:
Mechanical ventilation can be[2]:
Basic settings on a mechanical ventilator include:
Mechanical ventilator breaths[2] Breaths can be either controlled, assisted or supported by the ventilator.
The different modes of mechanical ventilators and all of them have different roles. See below for some examples:
[2] [2] Procedure of Weaning patient[edit | edit source]Weaning is gradual reduction of ventilation. A new systematic review suggests that noninvasive ventilation after early extubation helps in reducing the total days spent on invasive mechanical ventilation; also the patients spending less time on invasive ventilation had lower rates of ventilator-associated-pneumonia[4] . In some cases this process is rapid and uneventful; however, for some patients the process may be prolonged for days or weeks. Weaning is a term that is used in two separate ways. Firstly, it implies the termination of mechanical ventilation and secondly the removal of any artificial airway[5]. When to wean[5][edit | edit source]
The procedure is as follows:
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:
Physiotherapy Role in Mechanical Ventilation and Weaning[edit | edit source]Traditionally, physiotherapists have been involved in the respiratory care of patients on mechanical ventilation in ICU.[3] The respiratory care involves optimisation of ventilation, airway clearance, prevention of pulmonary complications, and hastening weaning from mechanical ventilation. Techniques used by physiotherapy to help improve patient breathing and wean patients off ventilators may include:
1) Evidence-Based Practice of Weaning from Ventilator: A Review[6] 2) Clinical Practice Guidelines for Weaning Critically Ill Adult Patients from Mechanical Ventilation[7] What is the procedure of ventilator?There are four stages of mechanical ventilation. There is the trigger phase, the inspiratory phase, the cycling phase, and the expiratory phase. The trigger phase is the initiation of an inhalation which is triggered by an effort from the patient or by set parameters by the mechanical ventilator.
What are the 4 modes of ventilator?Basic Modes of Mechanical Ventilation. A/C, VCV - Assisted/Controlled, Volume Cycled Ventilation.. A/C, PCV - Assisted/Controlled, Pressure Controlled Ventilation (time cycled). SIMV - Synchronized Intermittent Mandatory Ventilation.. PSV - Pressure Support Ventilation.. What is the criteria before weaning a patient off the ventilator?Vital capacity at least 10ml/kg or predicted body weight (no less than 1L for most adults) Negative inspiratory force at least – 20 cmH2O. Preferably, a endotracheal cuff leak should also be confirmed for orally/nasally intubated patients.
Can you wean off a ventilator at home?The answer to this question somewhat depends but in most cases Patients on long-term ventilation and tracheostomy can be weaned off it at home.
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