Weaning from the Ventilator - Algorithm

Setting up for extubation success

 • Decrease demand — correct metabolic acidosis, decrease CO2 production (fever, overfeeding, etc), reduce dead space.

 • Optimize mechanics - sit patient up, avoid gastric distension, consider draining pleural effusions

 • Improve strength — physical therapy, wean or avoid steroids & NMB

 • Respiratory drive — stop or reduce long lasting pain meds, combine with sedation vacation

 • Optimize Nutrition — feeding w/o overfeeding, correct electrolyte derangements (including Mg and PO4)

 • Diuresis — Dry lungs are happy lungs



Nick Mark MD @nickmmark



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