Liberation From Ventilators Case Study

Weaning ( Liberation from the ventilators) from the Ventilators:

The new and preferred term for taking the pateint out of ventilator support is liberation not weaning. There is some difference in these two terms. During weaning there is a gradual reduction of pressure or volume support and then weaned from the ventilator. Conversely, liberation is a term used for frequent assessment to see whether the patient can breathe spontaneously without support and based on that observation extubated. There are important criteria to be fulfilled before extubation. First of all, we have to be confident the reason for initial intubation needs to be resolved. For example if a patient was intubated for pneumonia or severe asthma, that pathology is reversed first and lungs appears clear. If the patient was intubated for shock the patient should be free of mental status changes and be from vasopressors to support boood pressure.

Secondly, Patient should be able to maintain normocapnia or adequate ventilation without positive pressure ventilation. There will be oxygen therapy

this is the third criteria for liberation from ventilators. A weaning trial on a T-piece can assess the patient to see whether he/she will tolerate spontaneous breathing. A stable mental status, to gain cooperation from the patient, is needed for extubation. Rapid shallow breathing index (RSBI) is a parameter used to guide the extubation process. This RSBI is calculated based on the principle that patients breathing is better when it is deep and slow and worse when it is slow and fast. In order to assess the efficacy of patients respiratory effort RSBI is calculated from the ratio of tidal volume to the respiratory rate. If the respiratory rate is 12 and the tidal volume is 400 RSBI=12/0.4=30. An RSBI less than 80-100 is considered ready for liberation. However, this index should not be the only