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Interventions 2 (RESP 319) > Extubating Neonates > Flashcards

Extubating Neonates Flashcards

1
Q

What are the primary things you should assess when considering extubation?

A
  • Spontaneous respiratory rates (appropriate age/weight)
  • Apnea or periodic breathing?
  • Look for downward trends
  • cough & gag reflex
  • minimal sedation needs
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2
Q

What mode should you put a babe on for a Spontaneous Breathing Assessment?

A

PRVC

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3
Q

How is a Spontaneous Breathing trial performed on a babe?

A

PRVC and roll back the RR until @ 20.

  • Once @20, if babe hits 40-60bpm they pass SBT and are ready for extubation.
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4
Q

What should you look for when assessing unsupported breaths?

A

Babes can’t trigger vents effectively so they induce WOB. look for:

  • RR
  • head bobbing, indrawing, paradoxical breathing.
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5
Q

How are kids and some bigger neonates assessed on a SBT?

A

Bigger kids can be put on pressure support like adults on 7/5 (initial).

  • Kids can use Automatic Tubing Compensation (ACT) to reduce WOB via ETT
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6
Q

What conditions are needed to use pressure support (PS) to be used on a SBT?

  • why isn’t it used?
A

Pressure support isn’t used when Pts don’t have enough muscle strength to trigger a breath.

  • 7 as PS, need to provide enough PS to overcome extra resistance provided by ETT
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7
Q

What is Automatic Tube Compensation (ACT)

A

Built in program where you input tube size and it figures
out resistance from endotracheal tube and give that much
pressure support

  • pressure support you set with ATC is 0
  • 0/5 + ATC
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8
Q

Why is high ICP dangerous and what is a high ICP?

A

Brain death, a high ICP < 15

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9
Q

What are contraindications for weaning kids and babes?

A
  • Brain death/high ICP
  • Paralytics running
  • unstable airways
  • team decisions
  • ECMO
  • babes w/genetic conditions
  • muscular atrophy pts or c-spine injuries
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10
Q

If a babe was intubated bc of epiglottis, would you extubate if swelling hasn’t resolved but the baby was stable?

A

Hell no

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11
Q

What issues should be addressed before extubation?

A

Reversal of underlying cause of resp. failure

  • Fluid overload, have we reached goals? are they +/-?
  • Meds that might affect their extubation (paralytics)
  • Time frame of tube feeds shut them off 4 hours before
    extubation
  • small bore and large bore
  • large bore is adults and older peds have ability to evacuate
    whatever is in the belly
  • Imminent procedure, they will delay extubation
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12
Q

What are the 3 stages of extubation?

A
  1. Initial/acute stage (escalation)
  2. Vent. Management (Plateau)
  3. Discontinuance (Deescalation)
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13
Q

What factors would make you stop a SBT in a babe/kid?

A

Increased WOB/unstable stats would end SBT and let patient rest and overcome

  • Tachypnea, bradypnea, apnea (age appropriate)
  • Excessive accessory muscle use
  • significant unresolved agitation/anxiety
  • significant unresolved tachy/bradycardia
  • hemodynamic changes
  • unacceptable decrease in SpO2
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14
Q

What information can you use to assess extubation status of a Pt?

A

ABGS and PF ratio, pay attention to time though.

  • PF ratio < 150 don’t extubate
  • Maintain ABG near the 1hr or 45min to see how they maintain gasses.
  • pH >= 7.25
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15
Q

Bedside Equipment for Peds/neonates during extubation

A

Suction equipment, Bagger

  • reintubation equipment nearby (doesn’t have to be in room)
  • possible racemic epi for swelling
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16
Q

What post extubation equipment should be ready?

A

CPAP and O2 therapy.

  • No delays
  • biphasic (try prior to extubation)
17
Q

How long can hyperoxygenation be done?

A

1-2 minutes. Ask team first though.

  • ensure they are oxygenated well.
18
Q

What should be done first in the extubation procedure?

A
  1. Verify orders
  2. Clean procedure (PPE)
  3. Consider presuction and meds
  4. Place Pt in high fowlers
  5. Place towel/pad on Pts chest to absorb secretions
19
Q

What do you need to consider for pre-suction for a extuabtion procedure?

A

Deep or oral suctioning?

  • deep suction of lungs if required, leave time for recovery
  • oral suctioning to lessen risk of aspriation
20
Q

What do you need to consider for meds for a extubation procedure?

A

Caffeine and bronchodilators given ahead of time to be active

21
Q

What position should a pt ideally be in for extubation?

A

High Fowler

22
Q

What should you set FiO2 @when extubating kids?

A

10% above their set FiO2 (need to fact check)

23
Q

What is apart of the post extubation assessment?

A

Monitofr Pt regularly for their:

  • RR
  • SpO2
  • WOB
24
Q

Assessing for extubation section needs review

A

Refer to kristines side notes

25
Q
A

Interventions 2 (RESP 319) (25 decks)

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