Long-Term Weaning A 75-yca.r-old man with COPD and oxygen dependence was admitted to the ED in respiratory distress. He was intubated and placed on the ventilator secondary to profound hypercarbia and...

Long-Term Weaning

A 75-yca.r-old man with COPD and oxygen dependence was admitted to the ED in respiratory distress. He was intubated and placed on the ventilator secondary to profound hypercarbia and acidosis and then transferred to the MICU for management of respiratory failure and right upper lobe pneumonia. On day 2, he meets criteria for his daily awakening trial but does not meet criteria for an SBT. Weaning assessment parameters included:

His sedation is at a minimal level with a sedation score of calm and comfortable, his delirium screen is negative, and on day 3 he ambulates with a walker while receiving ventilatory support, and is able to take several steps with minimal assistance. Long-term weaning is anticipated and the patient and family agree to a tracheostomy tube. He receives a tracheostomy tube on day 5 and is transferred on day 6 to the respiratory progressive care unit for further management and weaning. Additional major impediments to weaning as assessed by the unit team include

• Poor nutritional status (albumin 1.8 g/dL)

• Anxiety

• Debilitation

• Persistent upper lobe infiltrate

• Copious secretions

• Minute ventilation: 15 Umin with a Paco2 of 50 mm Hg

What weaning modality could be used in this patient for long-term wesning and why?

What components of the ABCDEF protocol were used for this patient?