2. The following are the few parameters to be considered to keep a patient from being able to wean on the ventilator (Laura, 2012)
3. The SIMV (Synchronized Intermittent Mandatory Ventilation) is mode of intermittent mandatory ventilation to provide partial ventilation in order to support the patient for mechanical ventilation. During SIMV, the patient can be provided with mandatory, synchronized and spontaneous breath. In the current case, the patient is supported of 10 with a rate of 4, VT of 700 with 40% FiO2. Then the patient was switchover to continuous positive airway pressure (CPAP) for 2 minutes. The observations as follows
3.1. What is RSBI?
The term, Rapid Shallow Breathing Index (RSBI) is a ratio used as an indicator for the assessment of respiration and decides the patient for weaning of ventilator. It can be measured by calculating the ratio of respiratory rate (f) and tidal volume (Vt) and a value below 105 of RSBI is considered as the accepted value for weaning of extubation (Crawford, Otero, Donnino, Garcia, Khazal & Lenoir, 2007). In the current case, the value is 0.028.
3.2. Would we be able to wean this patient and why?
Yes the patient can be weaned off for the ventilation based on the RSBI. It is below 105 therefore can be weaned off using suitable method
3.3. Which method of weaning would you use and why?
The methods that are used for weaning of ventilation include T-piece trials, SIMV and pressure support ventilation. Among the methods, SIMV can be sued for weaning. The method comprises of gradual decreasing the mandatory rate by 2 to 4 bpm (Jeremy & Mark, 2005). The gradual reduction prevent sudden onset of side effects and facilitate the patient for normal respiration.
4. Pressure Support Ventilation (PSV) is operated at preset pressure and it supports the patient in initiation of breath and regulation of certain parameters (breathing rate and tidal volume). Ideally, the ventilator should respond to a patient’s inspiratory effort. The factors that influence the sensitivity trigger include pressure, flow, and/or time. In the current case, the set parameters are not helping to trigger the ventilation and lead to increase in load on the respiratory muscles. Else, the time for of trigger stint may be prolonged due to the pressure transducer from the ventilator (Mellott, Grap, Munro, Sessler & Wetzel, 2009). Therefore the patient and ventilator interaction can be improved manipulating the pressure; flow and/or time E.g. Setting a shortest time for trigger will minimize the efforts of patient in terms of inspiration.
Crawford, J., Otero, R., Donnino, M., Garcia, J., Khazal, R & Lenoir, T (2007) Rapid shallow breathing index- a key predictor for noninvasive ventilation. Critical Care 11(Suppl 2) P169
George, Y., Nicole, AD & Andrew, MR (2013) Respiratory rate and breathing pattern MUMJ 10(1) 23-25
Jeremy, L & Mark, JG (2005) Weaning from mechanical ventilation Contin Educ Anaesth Crit Care Pain 5 (4): 113-117.
Laura, CPM (2012) Top 10 care essentials for ventilator patients American Nurse Today 7(3)13-16
Mellott, KG., Grap, MJ., Munro, CL., Sessler, CN & Wetzel, PA. (2009). Patient-ventilator dyssynchrony: Clinical significance and implications for practice. Critical Care Nurse, 29(6), 41–55.
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