Mr. Hill was kept sedated and paralyzed for 2 days. Today, he is completely weaned off of both drugs and is calm, arousable, and able to follow most commands. The pulmonologist wants to start weaning Mr. Hill so he orders the following: SIMV, rate 10, PS 10, FIO₂ 40%. Decrease the rate by 2 breaths every 2 hours, and decrease FIO₂ as tolerated.

1.  How will PS 10 assist Mr. Hill with the SIMV mode?

Answer:

Pressure support (PS) gives a positive pressure “boost” with each inhalation. This decreases the work of breathing through the ventilator tubing and circuits.

Six hours later, Mr. Hill is tolerating SIMV rate 4. You’ve also been able to decrease the FIO₂ to 30%. The pulmonologist orders an ABG and weaning criteria an hour after the last ventilator change.

The results of the ABG and weaning criteria are as follows.
ABG:	pH 7.42	Weaning criteria:	Vital capacity	12 cc/kg
	PaCO2 39		Negative inspiratory force	-30 cm H2O
	HCO3 25		Tidal volume	8 ml/kg
	PaO2  88		Minute volume	8 liters
			Respiratory rate	15

2.  Is Mr. Hill ready to be extubated?

Answer:

Yes!

3.  What form of oxygen therapy will you administer to Mr. Hill once he’s extubated?

Answer:

Humidified mask with oxygen at 30%. (The last FIO₂ setting he had while intubated.)

4.   How will you confirm that Mr. Hill’s respiratory status is stable after he’s extubated?

Answer:

Monitor pulse oximetry, vital signs, respiratory rate, breath sounds, ask Mr. Hill how he feels. Also remember to check another ABG 30 minutes after extubation (or per physician order).