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Ventilator Associated Pneumonia Sedation Vacation and Weaning Protocol

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ICU Nurses/Respiratory Therapist interactions HOB- Weaning- Sedation vacation. Monitoring done by ICU manager/RT ... Diaphoresis. Sedation Vacation ... – PowerPoint PPT presentation

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Title: Ventilator Associated Pneumonia Sedation Vacation and Weaning Protocol


1
Ventilator Associated Pneumonia- Sedation
Vacation and Weaning Protocol
  • Lisa Hamel, Cardiopulmonary Services Director
  • April 2005

2
Reliability/Redundancy for VAP
  • Order set
  • ICU Rounds daily- SUP/DVT
  • ICU Nurses/Respiratory Therapist interactions
    HOB- Weaning- Sedation vacation
  • Monitoring done by ICU manager/RT supervisor-
    Daily collection.

3
Ventilator Associated Pneumonia Rapid Action Team
  • Team Champion- Sharon Schneller
  • Team Leader- Lisa Hamel
  • Members
  • Judy Webber -IC RN Kathleen Frederick- ICRN
  • Marie Griffin- ICU RN Carol Reichel-ICU RN
  • Tom Pankonin- DPh Lance Lothert- CRTT
  • George Elliot- RD Irene Pfeffer- SW
  • Dr. Scott Sanders- Pulmonologist

4
Weaning Protocol
  • Protocol based on best evidence.
  • At least daily weaning attempt
  • Piloted with pulmonologists- three phases

5
ISJ Weaning Protocol
  • Phase I
  • Patient met weaning criteria, only Pulmonologist
    directed patients included and he/she authorized
    weaning trial.
  • Phase 2
  • Patient met weaning criteria, RCP initiated
    weaning trial.
  • Phase 3
  • Spread to all patients.

6
Weaning Trial Criteria
  • ISJ Respiratory Therapist-Driven Protocol for
    Weaning from Mechanical Ventilation
  • DAILY SCREENING
  • All patients deemed capable of spontaneous
    breathing will be screened each morning for the
    following
  • PaO2 gt 60mmHg on FiO2 lt 40.
  • PEEP lt 5cmH2O
  • Adequate cough during suctioning
  • f/Vt lt 105
  • No vasopressors or sedatives (dopamine not gt
    5micrograms/Kg/min, intermittent sedation ok)
  • lt moderate secretions.
  • If patients pass the daily screening test, a
    spontaneous breathing trial will be initiated.

7
Weaning trial
  • SPONTANEOUS BREATHING TRIAL
  • TC mode on same FiO2 with 3cmH2O PEEP for 2 hrs
    and obtain an ABG(sometimes optional)
  • Terminate trial if one of the following
    conditions occur
  • f gt 35 for 5 minutes
  • SpO2 lt 90
  • HR gt 140
  • Sustained change in HR of 20 in either
    direction.
  • BPsys gt 180 or lt 90 mmHg
  • Increased anxiety
  • Diaphoresis

8
Sedation Vacation
  • When patients are ventilated, a sedation vacation
    is attempted each day.
  • Coordinated between the RN and RCP.
  • At ISJ, we tend to keep patients light.

9
Sedation Vacation Procedure
  • Attempt to lighten the patient to state of
    following commands.
  • Assess for weaning
  • If criteria is met, a trial is initiated.
  • Coordination between the RN and RCP is key.

10
Building In Checks/Balances
  • Monitoring if all bundle information is
    accomplished is through interdisciplinary rounds.
  • Auditing through chart review and observation.
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