med 610 clinical respiratory diseases & critcare med

Mechanical Ventilation

Case 4

A 63 year-old woman was intubated four days ago for respiratory failure secondary to sepsis from a presumed pneumonia. She is on appropriate antibiotics, is now off pressors, and her WBC count has declined to the normal range. During your pre-rounding, you note that her FIO2 is down to 0.4 and she is on a PEEP of 5 cm H2O. On these settings, the ABG shows pH 7.36, pCO2 46, PO2 75, HCO3- 26. She has a weak cough and continues with copious secretions, requiring suctioning every 30 to 60 minutes.

At what point do you start considering whether your patient is ready to come off the ventilator?


How do you determine if the patient is capable of being separated from the ventilator?


Suppose your patient demonstrates that she can be separated from the ventilator. Should she be extubated?


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