Respiratory weaning is the process of withdrawing the patient from dependence on the ventilator, takes place in three stages: the patient is gradually removed from the ventilator, then from the tube, and finally from oxygen. Weaning from mechanical ventilation is performed at the earliest possible time consistent with patient safety. The decision must be made from a physiologic rather than from a mechanical viewpoint. A thorough understanding of the patient’s clinical status is required in making this decision.
Weaning is started when the patient is recovering from the acute stage of medical and surgical problems and when the cause of respiratory is sufficiently reversed. Successful weaning involves collaboration among the physician, respiratory therapist, and nurse. Each health care provider must understand the scope and function of other team members in relation to patient weaning to conserve the patient’s strength, use resources, and maximize successful outcomes. This paper intent to: 1. give a background on mechanical ventilation 2. describe the process of weaning the patient from mechanical ventilation.
3. understand the criteria for weaning 4. explain the methods of weaning 5. discuss the patient preparation who undergoes weaning ventilation I. Introduction Dependence on a ventilator is frightening to both the patient and family and disrupts even the most stable families. Encouraging the family to verbalize their feelings about the ventilator, the patient’s condition, and the environment in general is beneficial. Explaining procedures every time they are performed helps to reduce anxiety and familiarizes the patient with ventilator procedures.
To restore a sense of control, the medical group encourages the patient to participate in decisions about care, schedules, and treatment when possible. The patient may become withdrawn or depressed while on mechanical ventilation, especially if its use is prolonged. To promote effective coping, the medical informs the patient about progress when appropriate (Estaban, 2002). It is important to provide diversions such as watching television, playing music, or taking a walk (if appropriate and possible).
Stress reduction techniques (e. g. , backrub, relaxation measures) help relieve tension and help the patient to deal with anxieties and fears about both the condition and the dependence on the ventilator. II. Literature Review Mechanical ventilation may be required for a variety of reasons, including the need to control the patient’s respirations during surgery or during treatment of severe head injury, to oxygenate the blood when the patient’s ventilatory efforts are inadequate, and to rest the respiratory muscles.
Many patients placed on a ventilator can breathe spontaneously, but the effort needed to do so may be exhausting (Doherty, 2000). A mechanical ventilator is a positive- or negative-pressure breathing device that can maintain ventilation and oxygen delivery for a prolonged period. Caring for a patient on mechanical ventilation has become an integral part of nursing care in critical care or general medical-surgical units, extended care facilities, and the home. Nurses, physicians, and respiratory therapists must understand each patient’s specific pulmonary needs and work together to set realistic goals (Cull, 2003).
Positive patient outcomes depend on an understanding of the principles of mechanical ventilation and the patient’s care needs as well as open communication among members of the health care team about the goals of therapy, weaning plans, and the patient’s tolerance of changes in ventilator settings. If a patient has a continuous decrease in oxygenation (PaO2), an increase in arterial carbon dioxide levels (PaO2), and a persistent acidosis (decreased pH), mechanical ventilation may be necessary.
Conditions such as thoracic or abdominal surgery, drug overdose, neuromuscular disorders, inhalation injury, COPD, multiple traumas, shock, multisystem failure, and coma all may lead to respiratory failure and the need for mechanical ventilation (Ferreira, 2000). III. Methodology In order to make this study successful, the researcher used two different methods to make the investigation more informative and accurate. Aside from gathering information through internet, the researcher gathered information through statistics and observation that are conducted by the medical groups.
IV. Results and analysis Careful assessment is required to determine whether the patient is ready to be removed from mechanical ventilation. If the patient is stable and showing signs of improvement or reversal of the disease or condition that caused the need for mechanical ventilation, weaning indices should be assessed (Clini, 2003). These indices include: • Vital capacity: the amount of air expired after maximum inspiration, Used to assess the patient’s ability to take deep breaths.
Vital capacity should be 10 to 15 mL/kg to meet the criteria for weaning. • Maximum inspiratory pressure (MIP): used to assess the patient’s respiratory muscle strength. It is also known as negative inspiratory pressure and should be at least –20 cm H2O. • Tidal volume: volume of air that is inhaled or exhaled from the lungs during an effortless breath. It is normally 7 to 9 mL/kg. • Rapid/shallow breathing index: used to assess the breathing pattern and is calculated by dividing the respiratory rate by tidal volume.
Patients with indices below 100 breaths/min/L are more likely to be successful at weaning. Other measurements used to asses readiness for weaning include a PaO2 of greater than 60 mm Hg with an FiO2 of less than 40%. Stable vital signs and arterial blood gases are also important predictors of successful weaning. Once readiness has been determined, the nurse records baseline measurements of weaning indices to monitor progress (Cull & Inwood, 2000).