CLINICAL PRACTICE GUIDELINE 37 Appendix D: Wean Discontinuation Protocol The following protocol is a policy/procedure used by Craig Hospital, Englewood, Colorado (December 1996). Rationale: To establish guidelines to be followed for discontinuing weans and required parameters during weans. G. Marked increase of complaint of shortness of breath or fatigue. *May be an indication to discontinue wean or cuff deflations by itself on the judgment of the RCP . H. Patient request. Scope: Respiratory care practitioners (RCPs) and all other clinicians with demonstrated competencies. II. Required documented parameters for all weans: A. FVC—forced vital capacity. B. TV—tidal volume. Policy Statement: The following criteria will be used for discontinuing weans of ventilator-dependent quadriplegic patients and required parameters for weans. C. RR—respiratory rate. D. HR—heart rate. E. SaO2—per RCPs discretion—oxygen saturation. F . NIF—negative inspiratory force. Procedure: I. Two or more of the following criteria must be documented to discontinue weans: A. RR increased to >35b/m. B. HR increased by 20 from baseline or is >130/minute or <60/minute. C. BP change of plus or minus 30 points from baseline or systolic pressure <70 or diastolic >100. D. SaO2 <92% with an FiO2 increase of 20 TORR higher than ordered. E. FVC <1/2 of documented patient baseline. F . Marked increase in spasms, diaphoresis, or change in mental status. G. V—minute ventilation. III. All weans of 5 minutes or less are required to have at least 1 set of parameters (FVC, NIF). IV All weans of greater than 5 minutes are required . to have pre- and post-FVCs and if patient is able, NIFs as tolerated. V . RCPs are to stop each wean if wean discontinuation criteria are met and may totally discontinue weans if problems continue for three consecutive times. VI. RCPs are to document reasons for discontinuing the weans in the progress notes and notify the physician.