The Wearing Process
The goal of placing a patient on a ventilator is to maintain oxygenation and gas exchange and ultimately to wean the patient off. The process of weaning can vary from short and uncomplicated to long with multiple complications. The decision to attempt the weaning process should be made collaboratively by the nurse, provider, and respiratory therapist as well as input from other departments. There are multiple ways to attempt to wean a patient from a ventilator; three common methods are SIMV, the T-piece technique, and pressure support ventilation. The healthcare team will decide which process to use and proceed with the weaning process (Ignatavicius et al., 2018).
In SIMV, as described previously, the patient can breathe on their own between breaths delivered by the ventilator. The rate is usually started at approximately 12 breaths per minute and is decreased as the patient makes progress until the patient is taking more breaths independently than the ventilator is providing. The T-piece technique allows the patient to be taken off the ventilator to breathe on their own for short periods of time, usually five to ten minutes. When off the ventilator, the patient is supported by a T-piece that connects over their airway or by a CPAP to deliver oxygen. The patient will continue to wean as they can maintain oxygenation off the ventilator for longer periods of time. Some patients will wean off the ventilator during the day and go back on the ventilator at night until they can support independent breathing. In pressure support ventilation weaning, the pressure of each inhalation is decreased gradually, or the number of breaths provided per minute is decreased until the patient has regained the ability to support full inhalations and an appropriate number of breaths. In any weaning method, the patient will be considered successfully weaned when they are independently breathing, and able to support appropriate oxygenation and gas exchange (Ignatavicius et al., 2018).