ICU-2 Ventilator Weaning Protocol



Apply this Algorithm on ALL Sedated / Mechanically Ventilated Patients on a daily basis

ICU CONSULTANT may override this protocol, with a valid documented justification in the patient’s file .

By Bedside Nurse:

WEANING TRIAL MONITORING CHART

|DATE |TIME |PROCESSES |NAME & BN |

| | |Step 1 | |

| | |Daily Sedation Interruption to done? | |

| | |YES (proceed to Step 2 after 1 hour) | |

| | |NO because evaluation point/s (A-B-C-D-E-F-G-H-I-J-K-L-M-N) | |

| | |Step 2 | |

| | |Daily Sedation Protocol Terminated? | |

| | |YES because monitoring point/s ([a-b-c-d-e-(___+___)] | |

| | |NO proceed to Step 3 after 1 hour | |

| | |Step 3 | |

| | |Respiratory Therapist Notified? | |

| | |YES (Name of the RT: _________________) | |

| | |NO because ___________________________ | |

|DATE |TIME |PROCESSES |NAME & BN |

| | |Step 1 | |

| | |Daily Sedation Interruption to done? | |

| | |YES (proceed to Step 2 after 1 hour) | |

| | |NO because evaluation point/s (A-B-C-D-E-F-G-H-I-J-K-L-M-N) | |

| | |Step 2 | |

| | |Daily Sedation Protocol Terminated? | |

| | |YES because monitoring point/s ([a-b-c-d-e-(___+___)] | |

| | |NO proceed to Step 3 after 1 hour | |

| | |Step 3 | |

| | |Respiratory Therapist Notified? | |

| | |YES (Name of the RT: _________________) | |

| | |NO because ___________________________ | |

-----------------------

DAILY SEDATION INTERRUPTION PROTOCOL

Step - 1

Sedated / Mechanically Ventilated Patients

Evaluation At 08:00 AM

Does the patient have ANY of the following?

A. Newly intubated (in less than 24 hours)

B. Needed escalating sedative dosages (Rate of infusion increased by 50% of last 6h)

C. Received ANY (infusion or stat doses ) paralytic drug within the last 24 hours

D. Systolic Blood Pressure (SBP) < 90 mmHg

E. Inotropes (Dopamine or Dobutamine at >5 mcg/kg/min, or Norepinephrine > 0.1mcg/kg/min)

F. On High Frequency Oscillatory Ventilation (HFOV).

G. Fraction of Inspired Oxygen (FiO2) > 50%

H. Positive End-Expiratory Pressure (PEEP) > 8 cmH2O

I. Peak Inspiratory Airway Pressure > 35cmH2O

J. Active Seizures

K. Increased Intracranial Pressure ( > 15 mmHg )

L. On head injury protocol

M. Documented Physician Order for "NO SEDATION INTERRUPTION"

1.

Action - 1

• Keep the Same

• Discuss with

Team on rounds .

Yes

None of the above

•

Step – 2 at 09:00AM

Stop ALL Sedative agents (Infusion and PRN)- propofol, midazolam, lorazepam

Stop ALL INFUSIVE Analgesic agents and get physician orders for PRN doses - fentanyl, morphine

If on dexmedetomidine try to wean to ................
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