What are mechanical ventilators? Part 3: when to extubate

Every intubated patient deserves a spontaneous breathing trial every day!

When should you think about extubating someone?

  1. mental status? Do they have the cortical connections to breathe on their own? Are they hypoventilating?
  2. M/S strength: do they have good respiratory muscles?
  3. Cough/gag/secretions?
  4. Is their lung disease resolved?

There are several ways to “wean” someone off a vent:

  1. T-piece for 30 mins. CHF.
  2. PSV 8/5 for 2 hrs. Esp good for COPD or hypercarbic resp distress
  3. Extubate to Bipap. This gives a little extra PEEP so also good for COPD.

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