Resume Appropriate ventilator setting, Allow patient to rest for 24 hours

1. 5:00-noon daily, Assess patient for Spontaneous Breathing Trial (SBT) Sp02> 92% PEEP < to 8 cm H20 Fio2 < 0.4 – 0.5 Minute ventilation is < 20 L/min Hemodynamic stability (Off Nitric and/or Flolan) HR > 50 < 140bpm SBP > 90 < 180 mmHg Patient initiates spontaneous inspiratory efforts Patient Performs the following simple commands: Open and close eyes Open and close mouth Cough Perform forced vital capacity maneuver, achieving double the baseline tidal volume . Meets All Readiness Criteria NO VAD PT’S Check with NP first Yes Begin SBT with Fi02 of .4-.5, wait 3 minutes, measure Rapid Shallow Breathing Index (RSSBI), (SBT can be either T-Piece, PS + 5/+ 5 or TC Trial Resume Appropriate ventilator setting, Allow patient to rest for 24 hours NO RSBI <105 bpm/L RSBI >105 bpm/L Continue SBT. After 60 minutes assess whether: RR< 35 bpm Sp02 > 92% Change in HR < 20% Change in SBP < 20% Pt is not agitated, diaphoretic or anxious Pt coughs on command Meets all Extubation Criteria Yes Page Physician: Inform physician that patient meets extubation criteria Either: Obtain verbal order for extubation or wait for physician to arrive for bedside assessment within 15 minutes