Extubation: Difference between revisions
No edit summary |
(→Source) |
||
Line 38: | Line 38: | ||
==Source== | ==Source== | ||
Weingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22. | Weingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22. | ||
[[Category:Critical Care]] | [[Category:Critical Care]] | ||
[[Category:Procedures]] | [[Category:Procedures]] |
Revision as of 19:25, 11 May 2015
Algorithm is for patients who have only been intubated for a few hours
Inclusion
- Resolution of clinical issue requiring intubation
- Sat >95% on FiO2 40%, PEEP 5
- RR <30, SBP >100, HR <130
- Pt not known to be a difficult intubation
Preparation
- Turn off sedatives
- Leave opiods on at a low dose (e.g. fentanyl 50 mcg/hr)
- Allow pt to regain full mental status
- If pt shows signs of discomfort consider giving more pain medication
- Pt should be able to understand respond to commands
Testing for Readiness
- Ask pt to raise arm and leave in air for 15s
- Ask pt to raise their head off the bed
- Ask pt to cough (they should be able to generate a strong cough)
- Place on pressure support 5; sit pt up to at least 45 degrees
- Observe for 15-30
- If sat <90%, HR >140, SBP >200, severe anxiety or decreased LOC discontinue attempt
Procedure
- Have nebulizer filled w/ NS attached to a mask
- Sit pt up to at least 45 degrees
- Suction ETT w/ bronchial suction catheter
- Suction oropharynx w/ Yankeur suction
- Deflate ETT cuff
- Have pt cough; pull the tube during the cough
- Suctio nthe oropharynx again
- Encourage the pt to keep coughing up any secretions
- Place nebulizer on pt at 4-6 L/min
After Extubation
- Monitor closely for at least 60min
- If pt develops resp distress, non-invasive ventilation will often be sufficient
Source
Weingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22.