Liberation From Mechanical Ventilation

If the shock phase is completed, an appropriate arterial oxygen saturation at an inspiratory O2 fraction (FIO2) ? 0.5 and a positive end-expiratory pressure (PEEP) reaches ? 7.5 cm H2O and the patient has no apparent excessive respiratory distress (such as a minute ventilation > 20 l / min), then it will launch daily spontaneous breathing phases on the tee or with the help of CPAP ( “continuous positive airway pressure”) in the amount of 5 cm H2O. The patients who are capable of spontaneous breathing, breathe slowly and deeply, not fast and shallow. This finding has led to the development of “rapid shallow breathing index” (RSB). This is obtained when dividing the non-assisted breathing rate of the patient (breaths / min) by the tidal volume (in l). A value <105 can appear promising a spontaneous breathing. However, no reliable prediction can be made here of a single value. The decision to extubation of the patient from the question whether the breathing assistance can be given, in principle, to distinguish. For some time, the decision whether a patient should be extubated after a spontaneous breathing trial is no longer made after following the RSB index, but due to the clinical assessment during spontaneous experiment, supported by blood gas analysis. In patients who are doing a short one- to two-hour spontaneous breathing trial well and have favorable arterial blood gases values ??that extubation may be considered. The assessment of the level of consciousness and the presence of protective reflexes and safe airway patency are additional requirements.

Setting a ventilation procedure is most successful when the triggering factors of respiratory insufficiency were detected and eliminated. The gradual reduction of ventilatory support ( “weaning”) is not enough to do so. however, are the causes of failure eliminated, the respirator is no longer necessary. If these conditions are not met or if the patient’s recovery is not sufficient, the reduction of respiratory support is more likely to contribute to a delay in the course of treatment. It is now clear evidence that repeated daily spontaneous breathing trials reduce the duration of mechanical ventilation on the tee. This works better than a gradual reduction in respiratory rate in SIMV respiration, some studies also better than pressure support with phases ventilation. If the shock phase is completed, an appropriate arterial oxygen saturation at an inspiratory O2 fraction (FIO2) ? 0.5 and a positive end-expiratory pressure (PEEP) reaches ? 7.5 cm H2O and the patient has no apparent excessive respiratory distress (such as a minute ventilation > 20 l / min), then it will launch daily spontaneous breathing phases on the tee or with the help of CPAP ( “continuous positive airway pressure”) in the amount of 5 cm H2O. The patients who are capable of spontaneous breathing, breathe slowly and deeply, not fast and shallow. This finding has led to the development of “rapid shallow breathing index” (RSB). This is obtained when dividing the non-assisted breathing rate of the patient (breaths / min) by the tidal volume (in l). A value <105 can appear promising a spontaneous breathing. However, no reliable prediction can be made here of a single value. The decision to extubation of the patient from the question whether the breathing assistance can be given, in principle, to distinguish. For some time, the decision whether a patient should be extubated after a spontaneous breathing trial is no longer made after following the RSB index, but due to the clinical assessment during spontaneous experiment, supported by blood gas analysis. In patients who are doing a short one- to two-hour spontaneous breathing trial well and have favorable arterial blood gases values ??that extubation may be considered. The assessment of the level of consciousness and the presence of protective reflexes and safe airway patency are additional requirements. Sedatives and opioids can extend the machinelle ventilation. By accumulation of drugs produced a prolonged Sedierungsphase is possible. This can lead to futile attempts of Spontanisierung, even if the actual cause of respiratory insufficiency has been overcome. The level of sedation should be continually monitored and the withdrawal of Sedierungsumfangs be started as early as possible. One may use formalized protocols. A simple, intermittent method practiced daily exposure of sedation is also possible. Sedation is then interrupted until the patient is either awake and cooperative then or needs to be sedated again with the respirator or other disorders due to agitation, lack of coordination (asynchronous breathing). Unless a further sedation is necessary, this will start with half of the previous dose again and appropriately controlled. Several studies have shown that the mean duration of mechanical ventilation is reduced in institutions which either daily breaks from sedation or other Sedierungsprotokolle, and perform daily trials of spontaneous breathing.

Health Life Media Team

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