| 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 |