Weaning from the Ventilator - Algorithm Setting up for extubation success • Decrease demand — correct metabolic acidosis, decrease CO2 production (fever, overfeeding, etc), reduce dead space. • Optimize mechanics - sit patient up, avoid gastric distension, consider draining pleural effusions • Improve strength — physical therapy, wean or avoid steroids & NMB • Respiratory drive — stop or reduce long lasting pain meds, combine with sedation vacation • Optimize Nutrition — feeding w/o overfeeding, correct electrolyte derangements (including Mg and PO4) • Diuresis — Dry lungs are happy lungs Nick Mark MD @nickmmark #Weaning #Ventilator #Algorithm #Extubation #CriticalCare #Management
