1.
WEANING
VENTILATOR
DR. EKO SETIJANTO , SP.AN ,KIC

2.
WHAT MUST WE KNOW?
DEFINITION
PREDICTOR OF WEANING
CRITERIA OF WEANING
PROCEDURES
EXTUBATION ASSESSMENT
WEANING FAILURE

3.
WEANING
DEFINITION
“LIBERATION”, “DISCONTINOUATION”
Process to decrease the assistance of mechanical ventilator till
the patients are able to breath well by him/herself

4.
7 STAGES OF WEANING

5.
PREDICTOR OF WEANING
• RSBI = f (breath/minute)
• VT (L)
• Patient with RSBI <100 can be extubated successfully
RSBI
(Rapid Shallow
Breathing Index)
• Avoid severe hypoxemia (PaO2 less than 55 in FiO2
40%)
• PaO2/FiO2 ratio sometimes can be used
Blood Gas Analysis
• Normal Minute ventilation (VE) is ±6 L/menit
Minute Volume

6.
Predictor Value of
Successful Mechanical
Ventilator Weaning
based on Minute
Volume, Maximal
Inspiration Pressure,
and RSBI

7.
• Pimax less negative than -30 cmH2O can be successfully
weaned
Maximal
Inspiration
Pressure (Pimax)
• Normal Capacity is about 65 – 75 mL/ kg
• If 10 ml/kg or more can be as predictor of weaning
Vital Capacity
• Pressure that comes from first 0.1 second of oclusion
airway
• Normal value that can be predictor of weaning is 3.4 – 6.0
cmH2O
Airway occlusion
pressure

8.
WEANING
CRITERIA

9.
Criteria to
wean from
Mechanical
Ventilator

10.
PROCEDURE OF WEANING
• Assuming whether
patient can be
weaned or not
• SBT strategies
STEP 1
• Success ->
consider extubation
• Fail -> screening,
fix problem, try SBT
next 24 hours
STEP 2

11.
SBT (SPONTANEOUS BREATHING
TRIAL)
Weaning with SIMV
Weaning with PSV
Weaning with T-Piece/ CPAP

12.
CRITERIA
OF
SUCCESSF
UL
WEANING

13.
WEANING RESULTS

14.
ASSESSMENT TO EXTUBATE
STRIDOR AFTER EXTUBATE
ABILITY TO PROTECT AIRWAY
MENTAL STATUS
NIV or High Flow Nasal Cannula

15.
RISK
FACTOR OF
EXTUBATIO
N FAILURE

16.
WEANING FAILURE
Breathing Problem
Lack of Patient’s Effort
Abnormality of Breathing Muscle
Cardiovascular problem
Gas exchange

17.
CONCLUSION
WEANING is decrease mechanical ventilator assistance to train patient
breaths by him/herself
Consider whether patient is ready or not to start weaning
3 SBT strategies: SIMV, PSV, T-Piece/ CPAP
Weaning failure, try to screen and fix the problem, then try SBT for next 24
hours

18.
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THANK YOU