Extubation and Decannulation Weaning Flashcards
What is the difference between extubation and decannulation?
- Extubation is the process of removing an artificial tracheal airway
- Decannulation is the process of removing a tracheostomy tube
When is extubation and decannulation done a patient?
On patients who are not being mechanically ventilated?
Criteria for weaning patient for Extubation and Decannulation?
- Patient is hemodynamically and clinically stable
- Vent support reason is resolved/improved
- Can protect airway aka can manage oral secretions
- Adequate cough
- Is there a condition that required airway support
How do you assess adequate cough and gag reflex?
Suction
When is weaning assesment performed?
Prior to actual process of weaning
How do you know if a patient is clinically stable?
Patient has adequate CNS function
- Can maintain stable ventilatory drive
- Has adequate cough and can manage oral secretions
- Good LOC and little or no dyspnea
What oxygenation goals do we aim for when considering extubation/decannulation?
- FiO2 < 0.5 w/decent PaO2
- Good P/F Ratio (>300)
What are Indicators that a patient can protect their airway?
- what are we assessing?
Minimal risk for upper airway obstruction
- LOC (GCS>8)
- Able to manage oral secretions
- Intact cough reflex
- Positive cuff leak test
What does a cuff leak test generally entail?
(4 steps)
How long does feeding need to be d/c’d before extubation?
feeding/feed tubs should be d/c atleast 4-6hrs before extubation
How long should successful SBT trial run for?
30-120 mins
What should you check when monitoring a SBT trial?
Resolution of their disease state or condition
- Hemodynamic stability
- Adequate oxygenation
- Low FiO2
- PEEP
- Adequate ventilatory status
- PaCO2
- Normal pH
What equipment should you have for extubation?
What vital signs should you watch when extuabting?
Watch for signs of Oxygenation Failure and Ventilation failure
- ↓ SpO2, ↑ FiO2
- ↑ WOB
- ↑ Accessory muscle use
- ↑ Dyspnea
- ↓ LOC
What is considered a successful extubation?
If patient is able to remain extubated for 24 hours
- If patient deteriorates or requires reintubation before 24 hrs has elapsed, patient has failed extubation.