Extubation Procedure

Question 1

Extubation: How do you asssess readiness for a SBT? (5)

Answer 1

• Acute disease phase/underlying indication for ventilation is resolved
• SpO2 >90% w/FiO2 <0.50 and PEEP <8
• Hemodynamically stable
• Adequate mentation
• Assess cough and gag reflex

Question 2

Extubation: How do you perform a spontaneous breathing trial (SBT) for adults?

• Duration?
• Requirements?

Answer 2

• PSV 7/+5
• 30 mins for Pts ventilated <72 hrs
• Monitor the first 5 mins and every 15 mins after
• If SBT is passed successfully, PS may be increased for Pt comfort
• Check for cuff leak if SBT successful

Question 3

Extubation: Termination criteria of a SBT?

Answer 3

• RR ≤ 8 or > 35 breaths per minute
• RSBI/Tobin Score > 105
• SpO2 < 90% for more than 5 mins
• HR > 140 bpm
  acutely
• systolic BP ≤ 90 or ³ 180
  mmHg acutely
• Increased WOB
• New onset of sweating
  and/or anxiety

Question 4

What equipment should be ready for Extubation?

Answer 4

• Emergency airway equipment (DAM cart)
• PPE
• Bagger
• Suction
• Blue pad
• 10ml syringe
• Scissors
• O2 via prongs connected to flow meter

Question 5

What are the general steps for a Extubation procedure (adult)

Answer 5

1. Verify order!!!
2. Set up equipment (preoxygenate pt)
3. Suction ETT, EVAC line, and orally
4. Explain procedure to patient
5. While holding ETT securely, remove securing device (tape/ETAD)
6. deflate cuff
7. pull ETT at end of inspiration (to help with timing: instruct your patient to take a big breath in and HOLD it)
8. Instruct patient to cough, suction mouth, apply oxygen
9. Perform full respiratory assessment – listen for stridor, count respiratory
   rate

Question 6

What position should the patient be in during extubation?

Answer 6

Full fowlers or semi at the least

Question 7

If you have time to assess VC, how do you test it?

Answer 7

Ask the patient to hold their breath. Assess Vt held as VC.

• want at least 10ml/kg

Question 8

What should you do before the procedure (precheck and tobin passed)

Answer 8

• Place the blue pad on the chest while explaining
• Setup the Pt on nasal prongs.
• Suction patient orally and endotracheally

Question 9

How long should you preoxygenate adult patients?

Answer 9

2-3mins w/100% FiO2

Question 10

When do you deflate the cuff

Answer 10

Cuff leak to assess readiness and after you untie the twill ties

• Basically, before and after procedure

Question 11

What should you do immediately after extubation?

Answer 11

Suction the mouth with yankeur and assess the patient.

• if stridor is present, apply large volume neb

Question 12

How should you preoxygenate neos and kids before extubation?

Answer 12

you don’t preoxygenate neos.

• kids you preoxygenate by 10-15% above their current FiO2 settings