| A. Appearance/Clinical Signs |
|---|
| a. No diaphoresis, healthy skin color (no cyanosis) |
| b. Spontaneous cough and gag reflex |
| c. No accessory muscle use or paradoxical breathing |
| d. Clear, improved and adequate breathing sounds |
| e. Significant improvement or reversal of the underlying disease process |
| f. Patient opening eyes, able to follow simple commands |
| B. Weaning Parameters |
| a. FiO2 is equal to or less than 50% and PEEP is less than or equal to +5 |
| b. Total respiratory rate in the range of 12-40 breaths per minute |
| c. Tidal Volume > 5 ml/kg ideal body weight |
| d. Vital signs stable |
| e. Fluid balance stable |
| f. F/Tidal volume ratio <100 |
| C. Review of recent laboratory values |
| a. Arterial blood gas approaching the patient’s baseline |
| b. Acid-base balance is corrected (optional) |
| c. Electrolytes are normal |
| d. Complete blood count near-normal baseline (optional) |
| e. Albumin > 2 gram/deciliter (optional) |
| f. Consult physician on any abnormal laboratory results for further orders. Any recommendations require written orders using appropriate Telephone Order Read Back (TORB) form |
| * If the patient develops any of the following changes in condition or abnormal findings since this protocol was initially initiated by Physician, call the physician for approval before proceeding |
| D. Patients meet Criteria Yes No |
| Weaning Guidelines Day#: Date: |
| a. Ensure protocol is ordered and signed by the physician or the physician has given specific weaning orders. |
| b. Patients should be stable and comfortable in present settings. |
| c. Perform a weaning assessment on the second day of admission and daily. If the patient is actively weaning, assessments are done every 4 hours during the day |
| d. Perform and document weaning parameters on Pressure Support Ventilation (PSV) of at least 5 cm of H2O daily, if stable unless otherwise ordered by the physician |
| e. Obtain arterial blood gas and consult a physician for further orders if abnormal. |
| f. Choose weaning plan A, B, or C if ready to wean. |
| * If the above guidelines are all met, proceed to the next plan. |