Question 1

A patient being actively weaned from mechanical ventilation currently is receiving the following ventilatory support: pressure support = 15 cm H₂O,spontaneous Vᴛ = 575 mL,spontaneous rate = 14 breaths/min,spontaneous Vᴛ = 500 mL,FɪO₂ = 35%,PEEP = 5 cm H₂O.The arterial blood gas results are: pH = 7.42,PₐCO₂ = 38 mm Hg,PₐO₂ = 94 mm Hg,SₐO₂ = 98%,HCO₃- = 24 mEq/L.What should the respiratory therapist do next?

Accepted Answer

At this point,the ABG results show no acid-base imbalance and no hypoxemia.The parameter that should be reduced is the pressure support.When pressure support is reduced to about 5 cm H₂O,the pressure level is not high enough to contribute significantly to ventilatory support.Once at PS 5 cm H₂O,the patient will be ready for a cuff leak test.

Question 2

How long does a tracheostomy site typically take to mature?

Accepted Answer

A tracheostomy site typically requires 7-10 days to mature.

Question 3

When weaning is unsuccessful for a patient who successfully performs an SBT,which of the following factors should be assessed?
1)Cardiac factors
2)Nutritional status and respiratory muscle strength
3)Acid-base status
4)Psychological factors

Accepted Answer

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Question 4

A patient who requires prolonged ventilatory support should not be considered permanently ventilator dependent until ________ month(s)has/have passed and all weaning attempts during that time have failed.

Accepted Answer

Unless evidence of irreversible disease exists,a patient who requires prolonged ventilatory support should not be considered permanently ventilator dependent until 3 months have passed and all weaning attempts during that time have failed.

Question 5

Which of the following would suggest that a patient is ready to be weaned from a ventilator?

Accepted Answer

The RSBI is the most frequently studied and one of the more reliable tests for determining a patient's weaning status.It is calculated by dividing the respiratory frequency (in breaths/min)by the Vᴛ (in L): f/Vᴛ.This measurement is taken 1 minute after disconnecting the spontaneously breathing patient from the ventilator and oxygen.Successful weaning is more likely if the RSBI is less than 105 (normal range,60-105).Values above 105 suggest that a patient is not ready for weaning and probably will fail a weaning trial.

Question 6

A patient in the ICU who has successfully completed a 120-minute SBT requires extubation.Which of the following tests or values would indicate the potential for airway edema after extubation?

Accepted Answer

The cuff leak test is a means of testing for post-extubation airway patency.Note that to qualify for this test,the patient must no longer need ventilatory support.To perform this test,the patient is disconnected from the ventilator,the cuff is deflated,and the ET or tracheostomy tube is obstructed.A leak around the cuff (peritubular leak)during spontaneous breathing suggests that the airway caliber is adequate and successful extubation is likely.A leak of less than 110 mL (average of three values on six consecutive breaths)indicates a high risk of post-extubation stridor.Treatment with steroids or racemic epinephrine (or both)before extubation may be indicated.

Question 7

A patient with amyotrophic lateral sclerosis has a tracheostomy tube in place.He has been unable to perform an SBT successfully and has been receiving mechanical ventilation for 4 months.An appropriate recommendation for this patient might be which of the following?
1)Transfer to a long-term care facility
2)Evaluation for the use of noninvasive ventilation (NIV)
3)Termination of ventilation
4)Waiting until the primary cause of respiratory failure has been resolved

Accepted Answer

Unless evidence of irreversible disease exists,a patient who requires prolonged ventilatory support should not be considered permanently ventilator dependent until 3 months have passed and all weaning attempts during that time have failed.Those failing to wean may require placement in a long-term care facility.

Quiz 20: Weaning and Discontinuation from Mechanical Ventilation

How long does a tracheostomy site typically take to mature?

When weaning is unsuccessful for a patient who successfully performs an SBT,which of the following factors should be assessed? 1) Cardiac factors 2) Nutritional status and respiratory muscle strength 3) Acid-base status 4) Psychological factors

A patient who requires prolonged ventilatory support should not be considered permanently ventilator dependent until ________ month(s) has/have passed and all weaning attempts during that time have failed.

Which of the following would suggest that a patient is ready to be weaned from a ventilator?

A patient in the ICU who has successfully completed a 120-minute SBT requires extubation.Which of the following tests or values would indicate the potential for airway edema after extubation?