Friday, January 18, 2008

Friday January 18, 2008
Revisiting Weaning ! - parameters to watch in SBT


Dr. Neil MacIntyre in his recent editorial (Critical Care Medicine) 1, simply put the following 7 measurements to watch in SBT (spontaneous Breathing Trial) beside RSBI - rapid shallow breathing index - f/VT.

Objective measurements


1. Gas exchange acceptability
  • Spo2 ≥85-90%,
  • Po2 ≥50-60 torr,
  • pH ≥7.32,
  • increase in Paco2 of ≤10 torr

2. Hemodynamic stability
  • heart rate <120-140>
  • heart rate not changed by >20%,
  • systolic blood pressure <180-200>90,
  • blood pressure not changed by >20%,
  • no pressors required

3. Stable ventilatory pattern e.g.,
  • respiratory rate ≤30-35 breaths/min,
  • respiratory rate not changed by >50%

Subjective clinical assessments
  • No change in mental status (e.g., somnolence, coma, agitation, anxiety)
  • No onset or worsening of discomfort
  • No diaphoresis
  • No signs of increased work of breathing (use of accessory respiratory muscles, thoracoabdominal paradox)


*
Editorial is written in respone to article in same issue from Tobin and Jubran: Meta-analysis under the spotlight: Focused on a meta-analysis of ventilator weaning
2.



References: click to get article

1. Ventilator discontinuation process: Evidence and guidelines , Critical Care Medicine:Volume 36(1)January 2008pp 329-330

2.
Meta-analysis under the spotlight: Focused on a meta-analysis of ventilator weaning , Critical Care Medicine. 36(1):1-7, January 2008. Tobin, Martin J. MD; Jubran, Amal MD

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