Figure 2.

Management algorithm of respiratory weaning after cardiac surgery. After the decision to wean is taken, a SBT is performed by either a T-piece trial or a PSV trial with low or no PEEP. If a SBT fails, possible cardiac and non-cardiac causes of failure need to be assessed and actively monitored during subsequent SBTs. Interventions to facilitate weaning include adequate fluid management, early initiation of physical therapy and nutritional support, and prevention and management of both delirium and postoperative pain. BNP, brain-derived natriuretic peptide; PAC, pulmonary artery catheter; PAOP, pulmonary artery occlusion pressure; PEEP, positive end expiratory pressure; PSV, pressure support ventilation; SBT, spontaneous breathing trial; TP trans-pulmonary; US, ultrasound.