PICU Ventilator Weaning — Clinical Signs of a Failed Wean — Clinical Pathway: ICU

Ventilator Weaning Clinical Pathway — PICU

Clinical Signs of a Failed Wean

For any of the signs/symptoms below, stop wean and reassess. A blood gas is not required for every wean. The use of blood gases with weans or ERTs is at the discretion of the provider team.

  • Increased FiO2 ≥ 40% sustained for > 6 hrs
  • Tachypnea and/or tachycardia if > 20% increase after respiratory rate change sustained
    for > 2 hrs and unexplained by other factors (fever, under-sedation, etc.)
  • Asynchrony with ventilator
  • Increased work of breathing (nasal flaring/accessory muscle use/retractions)
  • Increased EtCO2 /paCO2 on ABG and/or decreased minute ventilation (MV)

For a Failed Wean

  1. Discuss reasons for failure
  2. Consider and address reason for failure
  3. Re-evaluate child's ability to tolerate a wean in 6 hrs
Potential Reason for Failure Comments
Level of Sedation With ventilator setting reductions, particularly the respiratory rate, over-sedation may result in a child "riding the ventilator" and not initiating their own spontaneous breaths. Consider adjustments to sedative infusions, such as an opioid infusion wean, prior to the next ventilator wean.
Hypotension/Hemodynamic
Changes		 This is common in children who were in in hemodynamically unstable prior to weaning. Weans may induce increased work of breathing, decreasing preload and manifesting as hypotension.
Fluid Status Consider diuresis
Fever Consider new infection source
New Pneumonia Consider that the child may have a new infiltrate