Table 1B: Wean from Pressure Support to T-Collar. Weaning time 2 to 7 days.

A. Phase I-
a. Reduce pressure support (PS) level by 2 to 4 cm H2O each day as tolerated to maintain desired minute ventilation and respiratory rate.
b. PS is never to be less than 5 cm of H2O unless otherwise ordered by the physician
c. Once the patient is on a PS of 10 cm of H2O and can comfortably sustain an adequate spontaneous respiratory pattern for 4 hours, obtain an ABG, and consult with a physician for further orders.
B. Phase II-
a. Place patient on a T-collar 4 hours on, 4 hours off during the day, rest on PSV of 10 cm of H2O at night.
b. The FiO2 may be increased by 5-10% to maintain Oxygen saturations between 92-95%
c. Passy Muir Valve assessment will be completed by day 3 of T-Collar trials.
d. The patient will be treated by physical/ occupational therapy at the optimum time per collaboration with rehabilitation and respiratory therapy
e. Observe closely for fatigue. The patient will appear to struggle at times. The patient must be allowed to work. This will increase the patient’s endurance.
* Obtain ABG on day 1 and every 3rd day while the patient is on phase II. Inform the physician in case of any abnormal occurrence.
C. Phase III-
a. Place patient on T-Collar for 24 hours and check ABG
b. If ABG is acceptable, go to “Decannulation” Section
c. If ABG is not acceptable or the patient did not maintain 24-hour T-collar, move to Plan C
D. Phase IV-
a. Patients admitted with tracheostomy tubes or weaned off the ventilator without the goal of decannulation
b. Notify pulmonologist that the weaning phase is completed
c. Obtain a physician order to downsize tracheostomy tube to cuffless non-fenestrated