FINAL day 2 of 2 : WEANING . Lisanne Roesthuis. Weaning definitions starting with WIND study. #LIVES2022
#ventilation
#weaning #WeAreICU #TogetherICU #IntensiveCare #CriticalCare
@ESICM
#ventilation
#weaning #WeAreICU #TogetherICU #IntensiveCare #CriticalCare
@ESICM
@ESICM pubmed.ncbi.nlm.nih.gov/27626706/ Successful weaning (or successful separation) - extubation without death or reintubation within next 7 days. same for tracheostomy.
Different groups and trajectories 
ABCDE of weaning
1. airway and lung (compliance, resistance and gas exchange)
2. Brain (delirium, cognitive dysfunction)
3. Cardiac (Echo, after load reduction )
4. Diaphragm (Pi max, early mobilisation)
5. Endocrine.(adequate energy intake )
pubmed.ncbi.nlm.nih.gov/21143773/
1. airway and lung (compliance, resistance and gas exchange)
2. Brain (delirium, cognitive dysfunction)
3. Cardiac (Echo, after load reduction )
4. Diaphragm (Pi max, early mobilisation)
5. Endocrine.(adequate energy intake )
pubmed.ncbi.nlm.nih.gov/21143773/
Very comprehensive. Essentially excellent holistic icu care
Q: How to perform SBT?
a). low PS and PEEP
b). low PS without PEEP
c). using cPAP(i.e., PEEP)
d). T-piece with o2 supply
What would you do ?
a). low PS and PEEP
b). low PS without PEEP
c). using cPAP(i.e., PEEP)
d). T-piece with o2 supply
What would you do ?
PS under-estimates TRUE respiratory effort. but SBT with PS is more successful. pubmed.ncbi.nlm.nih.gov/31184740/
pressure support can mask cardiac failure due to PS reducing LV after load.
Potentially gastric pressure monitoring can also give additional information. Eadi - measure electrical activity of the diaphragm - more commonly known as "NAVA"
Potentially gastric pressure monitoring can also give additional information. Eadi - measure electrical activity of the diaphragm - more commonly known as "NAVA"
NAVA levels set accordingly - e.g., 2cmH20 per micro volt. What is the effect of PS on EA di ? atsjournals.org/doi/pdf/10.116…
in the failure to wean - EA di signal tend to increase significantly.
pubs.asahq.org/anesthesiology…
pubs.asahq.org/anesthesiology…
pubmed.ncbi.nlm.nih.gov/23478659/
There is a correlation between EAdi and Pmusc. but the gold standard is "of course - the oesophageal catheter".
There is a correlation between EAdi and Pmusc. but the gold standard is "of course - the oesophageal catheter".
So a lot of info here. Using pressure time curves to calculate WOB. You can see even having an ascites would shift to more wOB
With this we end our 2 day workshop. Now opening ceremony in 2015.
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