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The Winning Weaning Parameters

Parameter Normal Range Indications Definition

for Weaning
The number of respiration per
minute. This includes all
control, IMV/SIMV and
spontaneous respiration. An
elevated respiratory rate is
the compensating mechanism
for a drop of tidal volume as a
result of increased body
exertion. This increase,
Respiratory 10-20 <30 outside the normal range, is a
Rate breaths/min breaths/min* possible indicator of the onset
of fatigue associated with the
failure of the ventilatory pump
to maintain adequate output
in the face of the imposed
workload. A low respiratory
rate may result in
hypoventilation and a
respiratory acidosis.
 Delta Esophageal Pressure is
the pressure change in the
esophagus due to ventilation.
This measurement has been
reported to accurately track
changes in the pleural
pressure. During any
ventilation activity, airway
pressures maybe transmitted
across the pleural space to
Delta the esophagus. On patient
Esophageal 5-10 cmH2O <15 cmH2O initiated breaths, the true
Pressure value of Delta Esophageal
Pressure is the negative
deflection of the esophageal
pressure. On assisted breath
during mechanical support or
during controlled mechanical
ventilation, positive airway
pressure may be transmitted
across the potential space
causing a rise in esophageal
pressure above the normal
end esophageal pressure
point. Delta Esophageal
Pressure is an excellent
weaning indicator. Normal
Range for non-ventilated
patient is 2-10 cmH2O
Tidal Volume is the volume of
inhaled (VTins) or exhaled
(VTexp)gas per each breath.
This is monitored during
Tidal Volume mechanical ventilation to
7-10 ml/kg >5 ml/kg* determine if the level of
mechanical support is
adequate for the patient. It
may also be an indicator of
respiratory fatigue
Vital Capacity >15 ml/kg Yes, you should know this by
now!
Minute 5-10 <10 This one too!
Ventilation liters/minute liters/minute
 Respiratory Time Fraction
(TI / TTOT) indicates endurance
and is defined as the ratio of
the inspired time to the total
time of the respiratory cycle.
This value is a ratio and there
is no unit of measure. As the
respiratory muscles fatigue,
the fraction of the breathing
cycle spent in inspiration
TI / TTOT tends to increase. When there
Respiratory .3-.4 Increase of is respiratory muscle fatigue
Time Fraction >.1* and impending respiratory
failure the ratio between
inspiratory time and total time
available for the breath may
incrementally increase to a
point in which the respiratory
pump can no longer maintain
itself and the (TI / TTOT) may
decrease dramatically.
Excessive work of breathing
is the common cause of
elevated
(TI / TTOT)
WOBp .3-.6 joules/liter <.75
joules/liter*
Pressure Time Index (PTI) is
a measure of strength and
endurance combined into one
Pressure .05-1.2 <.15* value. It combines the
Time strength measurement of
Index esophageal pressure and the
maximum inspiratory pressure
with the endurance value of
respiratory time fraction.
 There are two kinds: Mean
Airway Resistance - the result
of friction in the patient
airways and endotracheal
tube throughout the entire
respiratory cycle. Expiratory
Airway Resistance is the
result of friction in the
Airway 2-5 <15 patient's airways,
Resistance cmH2O/L/sec cmH2O/L/sec endotracheal tube and
expiratory limb of the
ventilator circuit during
expiration only. Airway
resistance normally varies
inversely with lung volume
and increases in obstructive
and reactive airways disease.
It increases rapidly with
decreases in ET tube size as
a result of Poiseulle's Law.
Don't forget to subtract the
PEEP:-)
Lung 50-100 >25 If you don't know how to
Compliance ml/cm H2O ml/cm H2O calculate this parameter yet,
please drop me an e-mail and
include your school and your
instructor.
 Pressure Time Product (PTP)
is an estimate of metabolic
work (oxygen consumption) of
the respiratory muscles. This
maybe used to evaluate
patient effort to overcome
both mechanical and
isometric force of respiration.
PTP decreases with the
application of optimal
pressure support (PSV) and
continuous positive airway
pressure (CPAP). PTP varies
Pressure Time 200-300 directly with total lung
Product cm resistance. This variable is an
H2O/sec/min important indicator of the
actual patient effort to breath.
Any isometric muscle
contraction by the
patient exerted to overcome
Auto PEEP or to open the
inspiratory demand system
results in no tidal volume
change and, therefore,
accomplishes little or
no measurable work. In this
case, PTP may reflect the
patient's muscular effort more
faithfully than work of
breathing. Non- intubated
patients should average
between 60-80 cm
H2O/sec/min.
 Maximum Inspiratory
Pressure (MIP) is the
pressure change measured
by esophageal balloon, that
the patient can generate
when the airway is occluded
for several breaths. MIP is a
reflection of diaphragmatic
-30 cm H2O strength and may also be
Maximum low effort >-20 used to monitor respiratory
Inspiratory cm H2O* muscle endurance when
Pressure -140 cm H2O low effort serial measurements are
high effort made. MIP differs slightly
from the more commonly
used negative inspiratory
force (NIF), which is
measured at the mouth but
also reflects or measures
diaphragmatic strength.
Auto PEEP results when
insufficient expiratory time is
available between breath to
reestablish resting
equilibrium. A residual
alveolar pressure remains at
the end exhalation which is
Auto PEEP 0 <3 cm H2O undetected by the ventilators
circuitry. Causes of Auto
PEEP are: too large delivered
tidal volume, too short
expiratory time, increased
circuit impedance, low peak
inspiratory flows, high
respiratory rate, expiratory
airways obstruction or
dynamic airways collapse.
 P0.1 Respiratory Drive
actually measures the neural
drive to stimulate the force of
diaphragmatic contraction. It
is defined at the airway
occlusion pressure at the first
100 msec after airway closure
prior to the patient's
P0.1 Respiratory conscious recognition of
Drive 2-4 <6 occlusion. A heightened
cmH2O cmH2O Respiratory Drive increases
work expenditure during
patient initiated ventilator
breaths and may indicate a
problem in the
cardiopulmonary system. It
plays an essential part during
machine assisted breaths in
determining the energy
expenditure of the patient. A
low value for P0.1 Respiratory
Drive may indicate when
respiratory drive is blunted.
Problems with P0.1
Respiratory Drive therefore,
are important indicators of the
ability of the patient to wean
from mechanical ventilation.
The ratio of respiratory
frequency to tidal volume is
called the Rapid, Shallow
Breathing Index (RSBI). The
RSB Index 60-90 <105* ratio has proven to be an
(RR/Vt) accurate predictor of success
when weaning patients from
mechanical ventilation

*Research indicates that these pulmonary parameters may aid qualified personnel in evaluating weaning potential. If measured values
exceed acceptable range,
successful weaning may be less likely. Ranges from these parameters are not intended as a substitute for clinical assessment.