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Daily Spontaneous Breathing Trial ProtocolStarted on Day 1 after intubation and repeated daily while on sedation vacationAsses for readiness to extubate= “Readiness Testing”Cause of the respiratory failure has improvedPaO2 > 60 mmHg on FiO2 < 0.40 with a positive end-expiratory pressure of < 5 cm H2O; PaO2PaO2:FiO2 ratio > 150 mmHg on FiO2 < 0.40 with a positive end-expiratory pressure < 5 cm H2OpH >7.25 on abgSBP >90 but <180 mmHg, HR >50 but <120Patient is able to follow commands (i.e can initiate inspiratory effort)Temperature < 100.2 degrees FMinimal sedatives/vasoactive meds requiredIf all assessment criteria are met, begin the Spontaneous Breathing TrialVentilator Settings- If cause of respiratory failure is due to CHF, put on T-Piece. (Physician will specify)- If cause of respiratory failure not CHF, trial is done on CPAP with PS of 7 and PEEP of 0.Spontaneous Breathing TrialSet ventilator according to aboveConduct SBT for 30 minutesAt conclusion of SBT: get RSBI, NIF, and ABGIf RSBI < 80, NIF < -25, and PaCO2 is not being retained Extubate*If RSBI > 80, NO NIF or ABG needed; return to previous ventilator settingsIf there is any concern over the patients readiness for extubation, call MDAbort the SBT for any of the following:Desaturation below 88%Increase in HR by 20 beats per minuteAccessory muscle use or paradoxical breathingSignificant change in BP (>20 mmHg change in either direction)DiaphoresisIf aborted, return to previous ventilator settings* extubate if patient has air leak, can protect their airway (sufficient cough and adequate level of consciousness) and not requiring frequent suctioning (volume of resp secretions minimal)____________________________________________________________________Physicians SignatureDate and Time ................
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