SBP PNP Analysis PDF

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Cardiopulmonary Services

Weaning/Lung Mechanics
Proc9.5

SPONTANEOUS VENTILATORY PARAMETERS

PURPOSE: To determine a patient's capability to maintain his/her own ventilatory status.

POLICY: 1. Obtain parameters on patients when requested by physician.


2. The following parameters shall be obtained when patient
cooperation/toleration permits:
a. Negative Inspiratory Force (NIF)
b. Spontaneous respiratory rate
c. Slow Vital Capacity (VC)
d. Minute Ventilation (VE)
e. VT (obtained by VE/RR) average VT in that minute.
3. All values will be charted on Respiratory Care Progress Notes or Ventilator
Flow Sheet.

EQUIPMENT:
1. Ventilator Monitor Kit
2. Respirometer
3. NIF manometer
4. Mouthpiece (for all patients without artificial airways)
5. Nose clip, optional
6. Bacterial Filter

PROCEDURES:
1. Respiratory Rate (RR) and Minute Volume (VE)
a. Obtain monitor kit, assess type of airway, and obtain mouthpiece if
necessary.
b. Assemble monitor kit, noting placement of one way valves that allow for
inspiration/expiration.
c. Place bacterial filter proximal to respirometer and attach respirometer to
expiratory side of valve assembly.
d. Attach monitoring device to airway or place mouthpiece between
patient's lips. If mouthpiece is used be sure lips are properly sealed
around mouthpiece and patient does not breathe through nasal
passages (noseclip is preferred).
e. Instruct patient to relax and breathe as normally as he/she can. NOTE:
Patients who have just been removed from mechanical ventilation may
require a short period of time to begin to breathe spontaneously.
f. Reset the volume indicator to zero and not any patient monitors (heart
rate, pressure, etc.). Begin a minute count of respiratory rate. At end of
minute remove device and return patient to previous support.
g. Chart respiratory rate, minute volume, and calculate average tidal
volume.
h. These parameters (RR,VE, and VT) may be obtained via monitoring
capabilities on the mechanical ventilator with CPAP/PS mode (PS 0 and
PEEP 0 cmH2O) with appropriate sensitivity setting.

2. Slow Vital Capacity


a. Using the same setup as in the above procedure, reattach device to
patient's airway. Observe any patient monitors for any change in
patient's condition.
b. Instruct patient to exhale slowly and completely. At end expiration,
instruct patient to inhale deeply and then exhale slowly and completely.
c. Note volume exhaled. Repeat procedure one to two times and record
Cardiopulmonary Services
Weaning/Lung Mechanics
Proc9.5
best effort. If necessary place patient back on ventilatory support
between efforts and document tolerance.

3. NIF
a. Obtain negative inspiratory force manometer and ventilator monitor
kit.
b. Attach manometer to stem on T-piece from ventilator monitor kit and
attach T-piece to patient's ET-tube or mouthpiece to allow for
spontaneous inhalation and exhalation through the one-way valves. A
bacterial filter shall be in place between the NIF meter and the T-piece.
c. Instruct patient to attempt 8 to 10 maximum inspiratory efforts while
occluding the inspiratory side of the T-piece. Note the maximum
negative inspiratory force achieved.
d. Discontinue the procedure before 8 to 10 breaths are achieved if the
maximum negative inspiratory force begins to decrease or if the patient
shows signs of fatigue.

ACCEPTABLE WEANING PARAMETERS


a. VC (10-15ml/kg of ideal body weight)
b. VT (2-3ml/kg of ideal body weight)
c. RR (less than 25/minute)
d. NIF (-20 to -25cm H20)

NOTE: Between patients, the filters and monitor kit shall be replaced, and the respirometer
and NIF meter shall be wiped off with aseptic spray. Also once per week the
respirometer and NIF meter will be sent to CMS for sterilizing

O2 tubing to port

Insp filter

To pt (ETT or MP)
Cardiopulmonary Services
Weaning/Lung Mechanics
Proc9.5

Exp side

Close ports

To ETT or MP
REFERENCES:
1. AARC Clinical Practice Guidelines, 1993.
2. Clinical Practice standards of and recommendations from Critical Care and
Pulmonary Medicine. Approval of Medical Director.
3. Shapiro, Barry A., Clinical Application of Respiratory Care
4. Marini, John J., Ventilator Dependence and Weaning.

Written: July 1986


Revised: March 1988
Reviewed: January 1992
Revised: October 1992
Reviewed: October 1993
Revised: August 1994, November 1994
Reviewed: May 1998
Reviewed: August 2000
Reviewed: March 2003
Revised: June 2004

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