Weaning from mechanical ventilation

[hasanj]

Hi ,what is our roll in weaning patient from mechanical ventilation after open heart surgery
thanks

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[sdkashif]

After Open heart surgery extubation can usually be done at the first attempt off the ventilator; those who have received prolonged ventilation may take several days to be weaned, starting with short periods of spontaneous breathing which will be lengthened progressively as the patient gains strength and confidence.

During the initial period of spontaneous breathing vigorous chest clearance procedures should not be used as this could distress and tire the patient- so shortening his time off the ventilator. Instead he should be encouraged to do the breathing exercises and cough spontaneously, any secretions being aspirated. When the patient can manage long periods of spontaneous breathing-several hours each day-then breathing exercises, huffing and coughing can be carried out in alternate side lying using percussion, shaking, vibrations as necessary supplemented with endotracheal/tracheal suction to remove secretions. If necessary manual hyper inflation may be continued, but should be discontinued as soon as the patient can huff and cough effectively himself. IPPV may be useful in helping to wean the patient from ventilator.

Once a patient with tracheostomy tube has been weaned off the ventilator, the cuffed plastic tube may be changed for an uncuffed silver tube which has inner speaking tube enabling him to talk. Before this tube is finally removed the physiotherapist must ensure that the patient is capable of clearing his own secretions by huffing and coughing, and chest clearance procedures should be carried out to facilitate the removal of secretions. Once it is sure that the patient will no longer need suction to remove secretions, the silver tube will be removed and a dry dressing placed over stoma, which should heal in a few days, although over the stoma should be air tight as possible, the patient must be taught how to hold the site of tracheostomy with his hand during the coughing so that the secretions are coughed into the mouth and not through the stoma. If pressure is not applied, the high pressure of cough will cause air and secretions to leak through the stoma and the full force of cough is lost. Application of pressure may be reduced as the stoma heals until it may be stopped when the wound has healed completely.

[fire_ice]

hello,
if the patient is stable he wont be on the ventilator for more than 12 hours ,so there is no need to disturb the patient un necessarly as he will be off the ventilator soon!!!!! now if due to certain complications the ventilatory support is to be continued, then u have to act according to the patients presentations of symptoms make sure that no routine physiotherapy is given unnecessarily i.e given only if needed and indicated.