Table 1. Ventilator weaning protocol utilizing checkboxes.

A. Appearance/Clinical Signs
a. No diaphoresis, healthy skin color (no cyanosis)
b. Spontaneous cough and gag reflex
c. No accessory muscle use or paradoxical breathing
d. Clear, improved and adequate breathing sounds
e. Significant improvement or reversal of the underlying disease process
f. Patient opening eyes, able to follow simple commands
B. Weaning Parameters
a. FiO2 is equal to or less than 50% and PEEP is less than or equal to +5
b. Total respiratory rate in the range of 12-40 breaths per minute
c. Tidal Volume > 5 ml/kg ideal body weight
d. Vital signs stable
e. Fluid balance stable
f. F/Tidal volume ratio <100
C. Review of recent laboratory values
a. Arterial blood gas approaching the patient’s baseline
b. Acid-base balance is corrected (optional)
c. Electrolytes are normal
d. Complete blood count near-normal baseline (optional)
e. Albumin > 2 gram/deciliter (optional)
f. Consult physician on any abnormal laboratory results for further orders. Any recommendations require written orders using appropriate Telephone Order Read Back (TORB) form
* If the patient develops any of the following changes in condition or abnormal findings since this protocol was initially initiated by Physician, call the physician for approval before proceeding
D. Patients meet Criteria Yes No
Weaning Guidelines Day#: Date:
a. Ensure protocol is ordered and signed by the physician or the physician has given specific weaning orders.
b. Patients should be stable and comfortable in present settings.
c. Perform a weaning assessment on the second day of admission and daily. If the patient is actively weaning, assessments are done every 4 hours during the day
d. Perform and document weaning parameters on Pressure Support Ventilation (PSV) of at least 5 cm of H2O daily, if stable unless otherwise ordered by the physician
e. Obtain arterial blood gas and consult a physician for further orders if abnormal.
f. Choose weaning plan A, B, or C if ready to wean.
* If the above guidelines are all met, proceed to the next plan.