When to start weaning off & extubate the patient from ventilator in ICU | regularcrisis

#regularcrisis #weaningfromventilator #extubatethepatientinicu
0:00 Introduction
0:50 Step 1
1:49 Step 2
2:41 Step 3
3:41 Step 4
4:24 Step 5
5:27 Step 6
5:38 All 6 Steps sum-up
7:10 Case 1
8:45 Case 2
10:37 Case 3
When to start weaning off and extubate the patient from invasive mechanical ventilation in ICU is a very basic question which an ICU doctor and nurse should approach in a systematic way.
The above video by Dr Ankur Gupta tries to answer this question in a very simplified way through a 6 step thinking process which can be applied easily at the patient bedside in ICU.
For support related to above video, visit regularcrisis forums at regularcrisis.com/forums/inde...
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regularcrisis.com is dedicated to doctors and nurses who regularly manage crisis like situations in ICU & ER.
Intensive care unit and emergency department are the backbones of any hospital where all critical situations are managed. Everyday is a crisis like situation there and with time the team working there get used to it with. With time, their skill gets more sharpen with which they manage these situations more and more efficiently each time.
But most importantly, the experience which they accumulate is invaluable; their experiences teach them things which at times are not mentioned in the regular textbooks. What if this experience is shared with the doctors and nurses who are newly joined in ICU and ER!
Regularcrisis.com serves this purpose only. We share educational material (mainly videos and forums discussion) which is a blend of latest guidelines and rich experience of ICU and ER teams.
We hope that his small effort of ours will be of some help to those working in ICU and ER.
Update: regularcrisis.com is now affiliated with ESBICM* for creating educational videos for health care working in ICU and ER.
*Educational Society of Bedside Intensive Care Medicine
regularcrisis is founded by Dr. Ankur Gupta, an Intensivist.
#drankurgupta

[@tnewman4218]

These gentlemen deserve a medal. They seem to REALLY wanting to help others understand what goes on with ventilators and extubating and steps to follow according to each case. God Bless these men and those like them.

[@ginaflores5986]

My dad is 74 years old and was in a car accident my dad is very active so to see him in life support is hard it's been 3months the dr. Told me he was only been moved to icu for better observation and in less than 24hours he was in a ventilator my dad look fine when I left the hospital he just had a fever

[@seemabavaria20]

Very simply explained 👍👍really thnq for gaining knowledge

[@pankajdhimanns]

Thanks a lot for brilliant explanation, my mom is on ventilator support and ICU doctors doesn't explain much, now I have got good idea and as a layman I think this is enough info 👍

[@TheICUChannel]

Wish a speedy recovery for her

[@lTechandTick1863]

how was she now?

[@shaynewheeler9249]

Ra Stargate swamp mummy

[@enjoythelife4899]

Thank you sir . Clear explanation about weaning off..

[@hiheamu6179]

Great doctors 🙏🙏Good doctors see in rare, in type of doctors

[@rabindraprasad8599]

Thank you very much sir for sharing valuable knowledge.... God Bless You...

[@dr.navedalam1333]

And thank you for explaining in easy way

[@abhijitchatterjee7408]

Great ! heartiest thanks for making these kind of educational videos which will help the doctors to work more scientifically.

[@TheICUChannel]

Our pleasure!

[@teresagevedon5856]

Thank you so much for this review on when to begin weaning off the ventilator. My sister has been on vent for 9 days and I see areas now which will require improvement before weaning will be possible. Thank you again!!

[@vasi5477]

Great job doc.

[@icemanaxs]

Great Video clearly explained with real world examples. Thank you

[@TheICUChannel]

Thank u

[@sunitasaple9977]

Thanku very much sir So simply you explained God bless you

[@TheICUChannel]

God bless, thank u

[@homeolove]

Excellent information .......thanks from my cre of heart ....kam time me bohot kuch mi jata he aapse ....thanks again

[@TheICUChannel]

Thanks vishal , glad it helped

[@aliia6045]

Excellent

[@abooodwa7sh]

Amazing video and explanation thanks alot for sharing such valuable information

[@TheICUChannel]

Thanks for liking

[@gairanliuthaimei5242]

Thank you sir🙏

[@moradzayed]

thank you so much

[@amreensultana1369]

Tq so much

[@sarangjaiswal3789]

Thank you sr

[@peiyin390]

Good Explaination dr! Thankyou

[@TheICUChannel]

thank you, welcome

[@bltbree]

Thank you, my husband is on a ventilator right now. It’s been 4 days in hospital for 8 day. Issue with him is that he was have severe panic attacks and not comprehend what and how he should be breathing. So his dr. Said his X-rays were not improving. Tomorrow a new X-ray will be done. They have backed I’m off 10% so the nurse said if tomorrow there is a improvement they will back off more. Thank you all for what you do.

[@TheICUChannel]

Thanks . But didn’t get the required details from the above message . U can mail us .

[@kennedyngandwe2792]

This is good.

[@harihara3271]

Good video

[@caroverine2063]

Excellent!

[@TheICUChannel]

Thanks

[@sanjeetbehera5620]

Great

[@hariakashrajrockzz9990]

Tnq u so much for this valuable information sir it will helpful for us who works in ICU and this video solve my douts on weaning and extubation 😊

[@TheICUChannel]

Glad it was helpful .

[@mayanneish]

Thank you so much for this very informative video. ♥️

[@TheICUChannel]

Thanks for the words , glad you liked it

[@mayanneish]

@@TheICUChannel i'm an ICU nurse too but was out of practice for more than a year now. This refreshed my mind.

[@TheICUChannel]

So glad you to have you . Nursing is very close to my heart .

[@adlesal24]

Magnificent

[@PeteHob]

In my personal case, the answer to when is before I become aware and alert. Taking into account that everything else is progressing properly. I do not want to be excavated while I am fully aware. But that’s just me.

[@TheICUChannel]

that's understandable , but. neurological assessment is a must in weaning.

[@lTechandTick1863]

does normal weakness cause weaning to be delayed?

[@soumyajitbiswas9518]

Thank you sir..

[@TheICUChannel]

Most welcome

[@drshalender5406]

Thanks and regards sir. Kindly also explain how pt is managed in case of hypercapnia and respiratory acidosis due to hypoxaemic condition and cardiorespiratory failure. Thanks again for excellent presentation of mechanical ventilation use in emergency medicine to tackle severe respiratory distress of type lll respiratory failure. Dr Shailendra jain

[@TheICUChannel]

Thanks dr Shailendra Jain, will definitely consider in coming sessions

[@lTechandTick1863]

sir, how are those 3 patients now? are they extubated and removed from ventilation ?

[@madhusudanmandal6128]

Want more lecture for MD anaesthesia student

[@user-ui4ru7cl5n]

How to contact you sir? My father is on ventilator

[@chandruganesan6636]

How to know cough is satisfactory or not sir? Thank u sir

[@elliemee4157]

My ftaher is on ventilator for 2 weeks after cardiac arrest. They took hi moff too early and then ignore he had trouble breathing because o2 was ok. O2 crashed and they had to reintubate. He is 88, with chf aortic valve stenosis, pm afib and other conditions. He is on antibiotic for aspiration pneumonia, food aspiration which was not properly treated caused the ca and needed ventilation. What is the safest way to wean him? They are constantly pressuring us. He had a fever last night but the are dong a pressure trials tonight and he was slumped over when I came in at first. I got them to place pillows around him to keep him upright. I don’t know if they have tested his cough but he has thick mucus and they are clearing it out but not enough. They took off chest fluid 4 days ago and said lungs look better with smaller pleural effusions which he had from prior covid and chf. I don't know if he has another another infection. They changed the antibiotic, wbc is slightly elevated. I asked them yo clear out his tube now during the trial but they haven’t done it yet. One respiratory therapist wanted to give him a drug for the mucus but the doc disagreed. They have been using saline I think to flush it out and clearing it.

[@thinkpink0608ify]

My mom is on a vent for pneumonia as well. The docs said to wait to see how the infection heals and then they will assess to see if she can breathe on her own.

[@kostasvarkoulis1678]

How do you check for cough when they re intubated and under light sedation in order to keep the tube. You stop sedation and let them cough while having the tube on?

[@Nikhil-gf8im]

They do suction and check the quantity

[@TheICUChannel]

This is not exact way of describing it but some what related to it … it’s called weaning protocol .

[@haradhanbkowmik5084]

Sir please make a video of ventilator settins management .

[@TheICUChannel]

exactly which type of video do you want ... can u elaborate so that we can make

[@thencb41]

Very good explanation. My mom is on ventilator and they wanted to perform a tracheotomy, but because she previously had a tracheotomy the ENT doesn’t want to do it because of the potential scar tissue from a tracheotomy that she had 6 years ago. She had a subdural hemorrhage in 2016. She had recovered mostly. She is obese and that also scares the doctors. My question is if she can’t get another tracheotomy, what will have to happen so that she can be extubated? She’s conscious, following commands, has a good cough with minimal secretions. Thank you for your easy to understand explanation.

[@mariespi96]

Hope your mom was able to get weaned off. People do get tracheostomy twice. Not in the exact same spot. Maybe a little lower. I don’t think her weight should have had anything to do with it. Hope she’s doing better.

[@drvishalparmar]

❤❤❤

[@hariprasath2109]

In case of opc poisoning,under atropine infusion ...having fever and all parameters are met... whether they are fit to be extubated?

[@TheICUChannel]

the criteria is same, you need to access consciousness, respiratory efforts plus chest expansion and special attention whether patient will be able to protect airway or not.

[@hariprasath2109]

@@TheICUChannel thank you sir

[@saptarshibhattacharya]

Case 1: We can see that the patient's BP (Systolic) is somewhere near 90 or so. And also her SpO2 level was 70% on 100% oxygen on Ventilator. So, she might require ECMO support. Right?

[@TheICUChannel]

many things to consider, but as per blood gas status, should consider.

[@DARK-py4bd]

Hi Sir,My mother admitted in hospital for Covid treatment,She is with NIV support from last 6 days,Till 3 days before her O2 maintained with 100% FIO2 84 only but from last 3 days with PEEP 2 and FIO2 50% her O2 is maintaining 91-93 in all positions. Is it a good time to trial using normal oxygen support? She is conscious and responding for all commands from doctors and nurse and she can able to convey message to us. Please suggest

[@TheICUChannel]

U r a doctor ?

[@DARK-py4bd]

@@TheICUChannel No

[@dr.navedalam1333]

Please let us know the steps of weaning off venti

[@TheICUChannel]

Noted

[@hamropurkha]

Sir my dad is in ventilator how crp Was 36 lymphocytes 15 tlc 20000 neutrophils 85 pco2 100 po2 136 ph7.36 what the chancess

[@TheICUChannel]

Just can’t tell on these parameters, need to understand the case in all

[@madanpandit6046]

In your practice and experience how much percent of patients had wean the ventilator if took on it after that.

[@TheICUChannel]

Depends on primary condition

[@ankumar1992]

my father is on ventilator for last 4 days doctor told us now they are going to extubate him but it's been 2 days all the sedation medicine are off and everything is looking good but he is not opening his eyes and keep moving his head and leg continuously.

[@TheICUChannel]

As such can’t comment , need to see patient in full ... there are many things to be accessed at patient bedside

[@ChrisRI1000]

Thank you for mak8ng this video. As someone who only speaks English it can be difficult to follow what you're saying. Removing the masks when you are in an area where they aren't required or filming in an area that doesn't require masks would work much better. Also slowing down while talking would be better as well because words run together too much. Between that and the mask muffling your words it is very challenging.

[@TheICUChannel]

Thanks kris … it was on the peak of 2nd wave … hope it passes on soon … your points noted … anything u didn’t get from video can ask here

[@JJJ-qx5gu]

With ventilator 40lpm of oxygen flow. Oxygen level is 80 . Is it curable? Or serious condition

[@TheICUChannel]

Depends on many parameters, can’t just say based only in above info

[@benjamind6423]

i cant understand any of this\

[@thencb41]

Change the playback speed to 0.75

[@madanpandit6046]

Mostly ventilator patients cannot wean it As all complications parameters are aroused due to being on ventilator itself so why such stupidity is introduced to critical patients.

[@TheICUChannel]

This is a myth not true statement

[@terryharleyrides6109]

Extremely hard to understand what he’s saying,........his voice is not clear enough to understand him.

[@TheICUChannel]

We crossed checked , voice is clear … please try again

[@trueroyalty3342]

Snap lol, double masked n everything.

[@meganharter6451]

How can anyone understand what he is saying? Like it's not hard enough because of his accent but then he puts a mask on too?

[@riddhigundani4621]

It’s called using captions and not being racist about accents.

[@M.albar373]

The Professor speaks excellent English with a very clear accent.. I hope you focus a little on what he says I'm not indian and I can Cleary understand what he said The video is for ICU dr

[@lynnorabennett8509]

Talking too fast. Moving on

[@TheICUChannel]

@lynnorabennett8509 you can slow down the speed or allow captions

[@barbikinkin]

I wish you would do this again with no mask

[@EdBenji]

I can't understand a word these two are saying!

[@TheICUChannel]

Enable captions in video .

[@c2shiningc903]

I can tell that the information is concise and helpful, but it would have been more so if you were not wearing a mask during the lesson. Please consider taking the mask off when teaching on KZbin. Not everyone has perfect hearing, and we can understand better seeing faces and mouths speaking. Please consider remaking this topic. Thank you!

[@TheICUChannel]

Session was made during covid times … but thanks for the input

[@allahhuakbar7362]

Excellent

[@TheICUChannel]

Thanks

[@anakhaps8457]

Thank you sir

[@TheICUChannel]

Welcome