Extubation - Revision history

Kfarzam: /* Preparation */

2022-08-20T05:49:07Z

Preparation

← Older revision		Revision as of 05:49, 20 August 2022
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	*If patient shows signs of discomfort consider giving more pain medication		*If patient shows signs of discomfort consider giving more pain medication
	*Patient should be able to understand and respond to commands		*Patient should be able to understand and respond to commands
			*Consider having airway exchange catheter if available

	==Testing for Readiness==		==Testing for Readiness==

Elcatracho: /* ProcedureWeingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22. */

2021-02-23T19:53:13Z

ProcedureWeingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22.

← Older revision		Revision as of 19:53, 23 February 2021
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	#Sit patient up to at least 45 degrees		#Sit patient up to at least 45 degrees
	#Suction ETT with bronchial suction catheter		#Suction ETT with bronchial suction catheter
	#Suction oropharynx with ~~Yankeur~~ suction		#Suction oropharynx with Yankauer suction
	#Deflate ETT cuff		#Deflate ETT cuff
	#Have patient cough; pull the tube during the cough		#Have patient cough; pull the tube during the cough

Elcatracho: /* Preparation */

2021-02-23T19:52:20Z

Preparation

← Older revision		Revision as of 19:52, 23 February 2021
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	==Preparation==		==Preparation==
	*Turn off sedatives		*Turn off sedatives
	*Leave opioids on at a low dose (e.g. [[fentanyl]] 50 mcg/hr)		*Leave [[opioids]] on at a low dose (e.g. [[fentanyl]] 50 mcg/hr)
	*Allow patient to regain full mental status		*Allow patient to regain full mental status
	*If patient shows signs of discomfort consider giving more pain medication		*If patient shows signs of discomfort consider giving more pain medication
	*Patient should be able to understand respond to commands		*Patient should be able to understand and respond to commands

	==Testing for Readiness==		==Testing for Readiness==

ClaireLewis: /* Preparation */

2019-09-27T15:19:38Z

Preparation

← Older revision		Revision as of 15:19, 27 September 2019
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	==Preparation==		==Preparation==
	*Turn off sedatives		*Turn off sedatives
	*Leave ~~opiods~~ on at a low dose (e.g. fentanyl 50 mcg/hr)		*Leave opioids on at a low dose (e.g. [[fentanyl]] 50 mcg/hr)
	*Allow patient to regain full mental status		*Allow patient to regain full mental status
	*If patient shows signs of discomfort consider giving more pain medication		*If patient shows signs of discomfort consider giving more pain medication

Rossdonaldson1: /* Testing for Readiness */

2019-05-08T07:26:50Z

Testing for Readiness

← Older revision		Revision as of 07:26, 8 May 2019
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	**Observe for 15-30		**Observe for 15-30
	***If sat <90%, HR >140, SBP >200, severe anxiety or decreased LOC discontinue attempt		***If sat <90%, HR >140, SBP >200, severe anxiety or decreased LOC discontinue attempt
	*Perform cuff leak test to assess airway patency (not needed for ED extubation for only few ~~hrs~~ per Weingart article)		*Perform cuff leak test to assess airway patency (not needed for ED extubation for only few hours per Weingart article)
	**Predicts post-intubation stridor with sensitivity of 56-92%<ref>Ochoa ME, Marín Mdel C, Frutos-Vivar F, Gordo F, Latour-Pérez J, Calvo E, Esteban A. Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis. Intensive Care Med. 2009 Jul;35(7):1171-9.</ref>		**Predicts post-intubation stridor with sensitivity of 56-92%<ref>Ochoa ME, Marín Mdel C, Frutos-Vivar F, Gordo F, Latour-Pérez J, Calvo E, Esteban A. Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis. Intensive Care Med. 2009 Jul;35(7):1171-9.</ref>
	**Cuff leak refers to airflow around ETT with deflated cuff		**Cuff leak refers to airflow around ETT with deflated cuff

Rossdonaldson1: Text replacement - " vent " to " ventilator "

2016-08-03T08:58:11Z

Text replacement - " vent " to " ventilator "

← Older revision		Revision as of 08:58, 3 August 2016
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	**Cuff leak refers to airflow around ETT with deflated cuff		**Cuff leak refers to airflow around ETT with deflated cuff
	**Qualatative measurement: deflate and listen for air with stethoscope		**Qualatative measurement: deflate and listen for air with stethoscope
	**Quantative measurement: measure difference between inspired TV while on ~~vent~~ and expired TV with deflated cuff (avg lowest 3 expired breaths over 6 cycles)		**Quantative measurement: measure difference between inspired TV while on ventilator and expired TV with deflated cuff (avg lowest 3 expired breaths over 6 cycles)
	**Positive cuff leak = volumes <110 mL or <12-24% of TV. This indicates decreased space between ETT and airway (laryngeal edema)		**Positive cuff leak = volumes <110 mL or <12-24% of TV. This indicates decreased space between ETT and airway (laryngeal edema)
	**If positive test, consider course of steroids and delay extubation		**If positive test, consider course of steroids and delay extubation

Rossdonaldson1: Text replacement - " resp " to " respiratory "

2016-08-03T06:41:12Z

Text replacement - " resp " to " respiratory "

← Older revision		Revision as of 06:41, 3 August 2016
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	==After Extubation==		==After Extubation==
	*Monitor closely for at least 60min		*Monitor closely for at least 60min
	*If patient develops ~~resp~~ distress, non-invasive ventilation will often be sufficient		*If patient develops respiratory distress, non-invasive ventilation will often be sufficient

	==See Also==		==See Also==

Neil.m.young: Text replacement - " w/ " to " with "

2016-07-12T03:48:00Z

Text replacement - " w/ " to " with "

Neil.m.young: Text replacement - "Pt " to "Patient "

2016-07-02T16:15:06Z

Text replacement - "Pt " to "Patient "

← Older revision		Revision as of 16:15, 2 July 2016
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	**Sat >95% on FiO2 40%, PEEP 5		**Sat >95% on FiO2 40%, PEEP 5
	**RR <30, SBP >100, HR <130		**RR <30, SBP >100, HR <130
	**Pt not known to be a difficult intubation		**Patient not known to be a difficult intubation

	==Preparation==		==Preparation==
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	*Allow patient to regain full mental status		*Allow patient to regain full mental status
	*If patient shows signs of discomfort consider giving more pain medication		*If patient shows signs of discomfort consider giving more pain medication
	*Pt should be able to understand respond to commands		*Patient should be able to understand respond to commands

	==Testing for Readiness==		==Testing for Readiness==

Neil.m.young: Text replacement - " pt " to " patient "

2016-07-01T20:46:39Z

Text replacement - " pt " to " patient "

← Older revision		Revision as of 20:46, 1 July 2016
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	*Turn off sedatives		*Turn off sedatives
	*Leave opiods on at a low dose (e.g. fentanyl 50 mcg/hr)		*Leave opiods on at a low dose (e.g. fentanyl 50 mcg/hr)
	*Allow pt to regain full mental status		*Allow patient to regain full mental status
	*If pt shows signs of discomfort consider giving more pain medication		*If patient shows signs of discomfort consider giving more pain medication
	*Pt should be able to understand respond to commands		*Pt should be able to understand respond to commands

	==Testing for Readiness==		==Testing for Readiness==
	*Mental Status<ref>Weingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22.</ref>		*Mental Status<ref>Weingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22.</ref>
	**Ask pt to raise arm and leave in air for 15s		**Ask patient to raise arm and leave in air for 15s
	**Ask pt to raise their head off the bed		**Ask patient to raise their head off the bed
	**Ask pt to cough (they should be able to generate a strong cough)		**Ask patient to cough (they should be able to generate a strong cough)
	**Place on pressure support 5; sit pt up to at least 45 degrees		**Place on pressure support 5; sit patient up to at least 45 degrees
	**Observe for 15-30		**Observe for 15-30
	***If sat <90%, HR >140, SBP >200, severe anxiety or decreased LOC discontinue attempt		***If sat <90%, HR >140, SBP >200, severe anxiety or decreased LOC discontinue attempt
Line 33:		Line 33:
	==Procedure<ref>Weingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22.</ref>==		==Procedure<ref>Weingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22.</ref>==
	#Have nebulizer filled w/ NS attached to a mask		#Have nebulizer filled w/ NS attached to a mask
	#Sit pt up to at least 45 degrees		#Sit patient up to at least 45 degrees
	#Suction ETT w/ bronchial suction catheter		#Suction ETT w/ bronchial suction catheter
	#Suction oropharynx w/ Yankeur suction		#Suction oropharynx w/ Yankeur suction
	#Deflate ETT cuff		#Deflate ETT cuff
	#Have pt cough; pull the tube during the cough		#Have patient cough; pull the tube during the cough
	#Suction the oropharynx again		#Suction the oropharynx again
	#Encourage the pt to keep coughing up any secretions		#Encourage the patient to keep coughing up any secretions
	#Place nebulizer on pt at 4-6 L/min		#Place nebulizer on patient at 4-6 L/min

	==After Extubation==		==After Extubation==
	*Monitor closely for at least 60min		*Monitor closely for at least 60min
	*If pt develops resp distress, non-invasive ventilation will often be sufficient		*If patient develops resp distress, non-invasive ventilation will often be sufficient

	==See Also==		==See Also==

← Older revision		Revision as of 03:48, 12 July 2016
Line 24:		Line 24:
	***If sat <90%, HR >140, SBP >200, severe anxiety or decreased LOC discontinue attempt		***If sat <90%, HR >140, SBP >200, severe anxiety or decreased LOC discontinue attempt
	*Perform cuff leak test to assess airway patency (not needed for ED extubation for only few hrs per Weingart article)		*Perform cuff leak test to assess airway patency (not needed for ED extubation for only few hrs per Weingart article)
	**Predicts post-intubation stridor w/ sensitivity of 56-92%<ref>Ochoa ME, Marín Mdel C, Frutos-Vivar F, Gordo F, Latour-Pérez J, Calvo E, Esteban A. Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis. Intensive Care Med. 2009 Jul;35(7):1171-9.</ref>		**Predicts post-intubation stridor with sensitivity of 56-92%<ref>Ochoa ME, Marín Mdel C, Frutos-Vivar F, Gordo F, Latour-Pérez J, Calvo E, Esteban A. Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis. Intensive Care Med. 2009 Jul;35(7):1171-9.</ref>
	**Cuff leak refers to airflow around ETT w/ deflated cuff		**Cuff leak refers to airflow around ETT with deflated cuff
	**Qualatative measurement: deflate and listen for air w/ stethoscope		**Qualatative measurement: deflate and listen for air with stethoscope
	**Quantative measurement: measure difference between inspired TV while on vent and expired TV w/ deflated cuff (avg lowest 3 expired breaths over 6 cycles)		**Quantative measurement: measure difference between inspired TV while on vent and expired TV with deflated cuff (avg lowest 3 expired breaths over 6 cycles)
	**Positive cuff leak = volumes <110 mL or <12-24% of TV. This indicates decreased space between ETT and airway (laryngeal edema)		**Positive cuff leak = volumes <110 mL or <12-24% of TV. This indicates decreased space between ETT and airway (laryngeal edema)
	**If positive test, consider course of steroids and delay extubation		**If positive test, consider course of steroids and delay extubation

	==Procedure<ref>Weingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22.</ref>==		==Procedure<ref>Weingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22.</ref>==
	#Have nebulizer filled w/ NS attached to a mask		#Have nebulizer filled with NS attached to a mask
	#Sit patient up to at least 45 degrees		#Sit patient up to at least 45 degrees
	#Suction ETT w/ bronchial suction catheter		#Suction ETT with bronchial suction catheter
	#Suction oropharynx w/ Yankeur suction		#Suction oropharynx with Yankeur suction
	#Deflate ETT cuff		#Deflate ETT cuff
	#Have patient cough; pull the tube during the cough		#Have patient cough; pull the tube during the cough