- See: Criteria for Extubation
- Decrease FiO2 to less than toxic levels ( < 50%)
- Use PEEP to wean FiO2; - Maintain Hb Sat > 90%
- Decrease mechanical rate: from IMV of 8 to 4 & check ABG
- Reduces mean intrathoracic pressure and frequency of exposure to Peak Inspiratory Pressure (PIP);
- Minimizes Barotrauma
- Improves V/Q mismatching;
- Decrease PEEP
- Increments of 2-3 cm per step;
- Check PO2 and/or Shunt, and if satisfactory, reduce PEEP;
- Allow increments of 6 hrs between successive drops in PEEP;
- Decrease PEEP to a base of 5 cm H2O; (approximates end expiratory pressure in extubated patients as a result of epiglottic closure; so called physiologic PEEP;
- If pO2 exceeds 75 mm Hg and pCO2 is less than 45 mm at each setting, then continue to wean;
- Attempt "Blow by" (O2 delivery only w/o Pos. Press. Ventilation)
- Do not Leave patient on Blow by for longer than 45 min. (patient has to work against resistance of air thru Endotrach tube)
- Continue to leave patient on at least 5cm of PEEP
- See Criteria for Extubation
