Extubation and Decannulation Weaning Flashcards

1
Q

What is the difference between extubation and decannulation?

A
  1. Extubation is the process of removing an artificial tracheal airway
  2. Decannulation is the process of removing a tracheostomy tube
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2
Q

When is extubation and decannulation done a patient?

A

On patients who are not being mechanically ventilated?

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3
Q

Criteria for weaning patient for Extubation and Decannulation?

A
  • 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
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4
Q

How do you assess adequate cough and gag reflex?

A

Suction

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5
Q

When is weaning assesment performed?

A

Prior to actual process of weaning

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6
Q

How do you know if a patient is clinically stable?

A

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
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7
Q

What oxygenation goals do we aim for when considering extubation/decannulation?

A
  • FiO2 < 0.5 w/decent PaO2
  • Good P/F Ratio (>300)
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8
Q

What are Indicators that a patient can protect their airway?

  • what are we assessing?
A

Minimal risk for upper airway obstruction

  • LOC (GCS>8)
  • Able to manage oral secretions
  • Intact cough reflex
  • Positive cuff leak test
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9
Q

What does a cuff leak test generally entail?

(4 steps)

A
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10
Q

How long does feeding need to be d/c’d before extubation?

A

feeding/feed tubs should be d/c atleast 4-6hrs before extubation

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11
Q

How long should successful SBT trial run for?

A

30-120 mins

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12
Q

What should you check when monitoring a SBT trial?

A

Resolution of their disease state or condition

  • Hemodynamic stability
  • Adequate oxygenation
  • Low FiO2
  • PEEP
  • Adequate ventilatory status
  • PaCO2
  • Normal pH
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13
Q

What equipment should you have for extubation?

A
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14
Q

What vital signs should you watch when extuabting?

A

Watch for signs of Oxygenation Failure and Ventilation failure

  • ↓ SpO2, ↑ FiO2
  • ↑ WOB
  • ↑ Accessory muscle use
  • ↑ Dyspnea
  • ↓ LOC
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15
Q

What is considered a successful extubation?

A

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.
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16
Q

What does stridor indicate after extubation?

A

Laryngeal edema or obstruction, causes could be from:

  • Smoke inhalation
  • Epiglottitis
  • Angioedema (dermal, subcutaneous or submucosal edema of the face or larynx)
17
Q

What could airway compression be caused by post extubation?

A
  • Tumor/abscess
  • Trauma
  • Post op head, neck, or oral surgeries
18
Q

Aside from reintubation, how could stridor be managed post extubation?

A
  • Cool aerosol with supplemental O2
  • Tx with nebulized 1:1000 epinephrine (5 mL)
  • Tx with Heliox mixtures by NRBM
19
Q

What could increase risk of aspiration post extubation?

A

If the Laryngeal reflexes are incompetent’s or deficit post extubation

  • common when there is imparied cough
20
Q

What is Odynophagia?

A

Painful swallowing or talking; could cause glottic infection or ulceration

21
Q

How are Trach’s weaned?

A

Make pt breathe on their own via:

  • Using progressively smaller tubes
  • Tracheal buttons
  • Fenustrated trachs
22
Q

Criteria for Decannulation of Trach?

A

Corked for 24h

  • able to manage secretions
  • pulmonary secretion’s not copious
  • able to cough effectively and clear pulmonary secretions
23
Q

Equipment for decannulation

A
24
Q

What position should a patient being extubated or decannulated?

A

Semi or high fowlers if possible

25
Q
A