Criteria for Extubation and Tracheostomy Tube Removal For Patients With Ventilatory Failure CHEST 1996 110:1566-71 John R. Bach,MD,FCCP; Lou R,Saporito,RRT,BS 49 62 34 24 intermittent positive pressure ventilation=ippv IPPV 2 IPPV PCF PCF 160L/min 160L/min PCF PCF 160L/min 43 PCF 160L/min 15 PCF 160L/min 4 2 2 160L/min PCF cough exsufflation mechanical ventilation muscular dystrophy poliomyelitis respiratory paralysis respiratory therapy ALS= IPPV= MAC PCF= SpO SCI= VC= VFBT=
VC 49 49 43 6 SIMV 43 34 24 2 7 1 10 39 6
5 COPD 2 COPD 60 Hg 92% SpO COPD TIPPV FEV1 FEV1FVC PCF apcf ml % L/ml L/ml h/d F/u C 72.0 7 870 75 120 300 S 24 12 24 72.9 7 700 60 250 250 S 15 2 0 46.3 6 320 31 250 250 S 24 24 24 73.5 6 730 61 <50 <50 F 24 2 24 53.0 4 650 55 190 190 S 8 22 8 TIPPV apcf assisted S F IPPV VC MAC Mechanically assisted coughing - In-Exsufflator cough machine cough assist JH Emerson Co. Mass Cambridge 4 7
VFBT IPPV VFBT SpO VFBT PCF ( Peak Flow Meter HealthScan Inc NJ Cedar Glove ) air stacking PCF 4 7 MAC IPPV MAC SpO COPD IPPV COPD SpO IPPV SpO MAC 30 50 H O 30 50 H O MAC MAC SpO VC SpO SpO
92% IPPV MAC 12 5 IPPV IPPV 7 IPPV VFBT 49 IPPV 2 SpO 3 MAC IPPV VC PCF SCI 6 SCI SCI COPD 5 2 p 0.05 37 49 22 15 15 11 2 1 1 25 12 7 5 7 5 2 37 9.4 13.1 1 65
26 19.8 21.6 0.2 70 IPPV 26 17 1 16.8 8.0 8 24 IPPV IPPV 17 24 19.5 65 SCI 3 3 3 55.6 26.3 14.0 11.3 IPPV 1470 304ml 477 258L/min 275
SCI 19 12 37.2 20.9 34.1 18.4 0.68 NS TIPPV 9.7 11.0 3.8 3.4 0.04 NS ml 1045 707 1053 467 0.97 NS / 12.8 10.7 8.7 10.4 0.29 NS PCF L/min 278 157 101 40 0.0001 0.0006 SCI 6 16 9 33.7 18.2 33.5 19.4 0.98 NS TIPPV 8.9 10.1 2.7 0.7 0.03 NS ml 966 725 1004 492 0.88 NS / 15.3 9.9 11.6 10.5 0.39 NS PCF L/min 242 100 104 44 0.0001 0.0008 32 17 42.9 18.4 38.9 18.3 0.47 NS TIPPV 11.2 15.0 5.8 6.1 0.09 NS ml 892 609 982 466 0.59 NS / 16.6 9.8 11.1 9.9 0.07 0.01 PCF L/min 259 128 103 40 0.0001 0.0001 SCI 13 5 51.4 9.4 50.6 12.7 0.88 NS TIPPV 13.2 19.8 10.8 8.7 0.80 NS ml 667 343 814 468 0.47 NS / 22.0 4.9 16.8 5.9 0.07 NS PCF L/min 229 60 110 43 0.001 0.001 * COPD 5 IPPV 1 PCF
air stacking 4
85 90% 0.2 360 1000L/min PCF 2.3 0.5L PCF PCF PCF PCF VC PCF 160L/ PCF 160L/ PCF MAC 45.4 PCF 120 170L/ MAC MAC MAC 600L COPD MAC 160 175L PCF MAC MAC
MAC VC SpO2 MAC ALS MAC COPD PCF 50 ALS 24 27 180L PCF 275 65L 23 150 80L VC 934 580mL PCF PCF VC 180L PCF ALS 160L PCF IPPV VFBT VC 160L PCF air stacking PCF VFTB COPD PCF
59 IPPV 24 160L PCF