Critical Matters Liberation From Mechanical Ventilation
Oct 8, 2020
Dr. Eduardo Mireles-Cabodevila, a pulmonary and critical care physician at the Cleveland Clinic, dives into the critical aspects of liberation from mechanical ventilation. He highlights the importance of distinguishing between 'liberation' and 'weaning'. Listeners learn about weaning classifications, SBT methods like pressure support vs. T-piece, and protocols that improve patient care. He also discusses nuances of managing COVID-19 patients, including sedation challenges and monitoring steroid side effects. This insightful conversation offers valuable strategies for critical care practices.
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Classify Weaning Early
- Use standardized terms: 'simple', 'difficult', and 'prolonged' liberation to categorize weaning trajectories.
- Track these categories because they correlate with mortality, ICU length of stay, and resource use.
Protocolize Liberation With RTs
- Run a respiratory-therapist driven liberation protocol with a brief readiness screen followed by an SBT.
- If they pass a 30-minute SBT, perform an extubation screen and extubate when criteria are met.
Keep Readiness Criteria Minimal
- Keep the readiness screen minimal: spontaneous trigger, FiO2 ≤40%, PEEP <8, pH >7.3, RR <35, limited vasopressors.
- Avoid extra steps (like routine RSBI) that slow workflow unless clinically needed.
