1. Meets all Extubation Criteria.
5:00-noon daily, Assess patient for Spontaneous Breathing Trial (SBT)
Sp02 > 92%
PEEP < to 8 cm H20
Fio2 < 0.4 – 0.5
Minute ventilation is < 20 L/min
Hemodynamic stability (Off Nitric and/or Flolan)
HR > 50 < 140bpm
SBP > 90 < 180 mmHg
Patient initiates spontaneous inspiratory efforts
Patient Performs the following simple commands:
Open and close eyes
Open and close mouth
Cough
Perform forced vital capacity maneuver,
achieving double the baseline tidal volume
Meets All Readiness Criteria NO
VAD PT’S Check with NP first
Yes
Begin SBT with Fi02 of .4-.5, wait 3 minutes, measure Rapid Shallow Breathing Index (RSSBI), (SBT can be either T-Piece, PS
+ 5/+ 5 or TC Trial
Resume Appropriate ventilator setting, Allow patient to rest for 24 hours NO
RSBI <105 bpm/L
RSBI >105 bpm/L
Continue SBT. After 60 minutes assess whether:
RR< 35 bpm
Sp02 > 92%
Change in HR < 20%
Change in SBP < 20%
Pt is not agitated, diaphoretic or anxious
Pt coughs on command
Meets all Extubation Criteria
Yes
Page Physician: Inform physician that patient meets extubation criteria
Either: Obtain verbal order for extubation or wait for physician to arrive for bedside assessment within 15 minutes