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
- Normal pH/PaCO2
- cough/gag intact
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.
What does stridor indicate after extubation?
Laryngeal edema or obstruction, causes could be from:
- Smoke inhalation
- Epiglottitis
- Angioedema (dermal, subcutaneous or submucosal edema of the face or larynx)
What could airway compression be caused by post extubation?
- Tumor/abscess
- Trauma
- Post op head, neck, or oral surgeries
Aside from reintubation, how could stridor be managed post extubation?
- Cool aerosol with supplemental O2
- Tx with nebulized 1:1000 epinephrine (5 mL)
- Tx with Heliox mixtures by NRBM
What could increase risk of aspiration post extubation?
If the Laryngeal reflexes are incompetent’s or deficit post extubation
- common when there is imparied cough
What is Odynophagia?
Painful swallowing or talking; could cause glottic infection or ulceration
How are Trach’s weaned?
Make pt breathe on their own via:
- Using progressively smaller tubes
- Tracheal buttons
- Fenustrated trachs
Criteria for Decannulation of Trach?
Corked for 24h
- able to manage secretions
- pulmonary secretion’s not copious
- able to cough effectively and clear pulmonary secretions
Equipment for decannulation
What position should a patient being extubated or decannulated?
Semi or high fowlers if possible
What does a vital capacity measurement demonstrate when assessing vital capacity?
VC shows overall strength of the ventilatory pump
- It demonstrates the patients ability to generate a cough
What is an acceptable VC to extubation off of?
A VC greater than 10ml/kg is acceptable
What is an adequate MIP value for weaning for extubation?
A MIP that is more negative than -20
How is stoma care performed on a decannulated patient?
Tapes and Tagaderm are applied in a manner that assists closure and keeps it covered.
- Trach care is performed as usual, single passes (no need for quadrants though). Wet than dry as needed.
