IPPVassessment of weaning Assessment prior to weaning

Prior to weaning it is important that the cause of respiratory failure and any complications arising have been corrected. Sepsis should be eradicated as should other factors that increase oxygen demand. Attention is required to nutritional status and fluid and electrolyte balance. The diaphragm should be allowed to contract unhindered by choosing the optimum position for breathing (sitting up unless the diaphragm is paralysed) and ensuring that intra-abdominal pressure is not high. Adequate analgesia must be provided. Sedatives are often withdrawn by this point but may still be needed in specific situations, e.g. residual agitation, raised intracranial pressure. Weaning should start after adequate explanation has been given to the patient. Factors predicting weaning success are detailed in list opposite. Spontaneous (pressure-supported) breathing should generally start as soon as possible to allow reduction in sedation levels, and maintain respiratory muscle function. Weaning with the intention of removing mechanical support is unlikely to be successful while FIO2 >0.4.

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