Author Question: The therapist, working in an LTAC, is planning to wean a PMV patient with combined SIMV and PS. What ... (Read 15 times)

piesebel · **on:** Jul 16, 2018

The therapist, working in an LTAC, is planning to wean a PMV patient with combined SIMV and PS. What should the therapist do in this situation?

A. The patient should be sedated, paralyzed, and placed on control mechanical ventilation before initiating weaning is attempted.
B. The combination of SIMV and pressure support ventilation is not recommended for PMV patients.
C. The therapist should proceed with the planned method of weaning.
D. Liberation from ventilatory support for this patient should employ VC-SIMV with CPAP.

Question 2

What is the current definition of weaning success as it pertains to PMV patients?

A. the ultimate removal of the endotracheal or tracheostomy tube
B. applying short periods of mechanical ventilation after 2 days of spontaneous breathing
C. No definition of successful weaning has been formulated for this patient group.
D. complete removal from ventilation for 7 consecutive days

krakiolit · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: B
A. Incorrect response: See explanation B.
B. Correct response: The combination of SIMV and PS is not recommended for PMV patients because of the unnatural combination of resultant tidal volumes and flow patterns for patients who are presumably not significantly sedated. This mode has previously been discredited as beneficial to the weaning process in large clinical trials. No clinical evidence supports the use of any particular ventilation mode over another with regard to speed and overall success with which liberation from full ventilatory support can be achieved.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.

Answer to Question 2

ANS: D
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: Weaning success is relatively easy to define in the acute ICU setting because it is marked by the successful removal of an ETT. However, for PMV patients who are ventilated via a tracheostomy, weaning success is less clear because the PMV weaning process can require short periods of ventilation after 2- to 3-day periods of spontaneous breathing before a patient is completely liberated from mechanical ventilatory support. Currently the recommended definition of PMV weaning success is complete removal from ventilation for 7 consecutive days.