Indicators of adequate ventilation

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  1. Several lung volume measurements are useful in monitoring ventilatory function in the operating room and ICU
    1. tidal volume – volume of air moved in or out of the lungs in any single breath; depressed tidal volume may cause difficulty oxygenating or ventilating
    2. vital capacity – maximal expiration following a maximal inspiration; 10 mL/kg is a good sign of ability to wean from the ventilator
    3. minute volume – total volume of air leaving the lung each minute; an increase in minute volume required to maintain a normal PaCO2 suggests an increased dead space
  2. PaCO2 directly reflects the adequacy with which alveolar ventilation meets metabolic demands for CO2 excretion; increased PaCO2 indicates inadequate ventilation
  3. Extubation criteria
    1. Respiratory: tidal volume (VT) > 6-8 mL/kg, respiratory rate (RR)<30-38/min, minute ventilation 10-15 mL/min, RR/VT <105/L, maximum inspiratory pressure >= -30 cmH2O
    2. Cardiovascular: no evidence of myocardial ischemia, heart rate <= 140/min, normal blood pressure without or minimal pressors requirement
    3. Mental status: GCS>= 13
    4. Absence of comorbid conditions
    5. Absence of significant electrolyte abnormalities
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