Indications for intubation and extubation

Question 1

What is the sniffing position?

Answer 1

Flexion of neck, extension of head

Question 2

When intubating-always confirm

Answer 2

Presence of suction and free flowing IV line

Question 3

What is FVC?

Answer 3

Forced vital capacity (FVC) is the amount of air that can be forcibly exhaled from your lungs after taking the deepest breath possible, as measured by spirometry

Question 4

FEV:

Answer 4

How much a person can exhale in one breath

Question 5

RSBI:

Answer 5

Frequecy/tidal volume (<60-100 breaths/min)

Question 6

Subjective criteria for extubtion:

Answer 6

Resolution of acute disease
adequate cough
Patient should be awake, alert, and following commands
Cooperative
Sustained head lift >5 seconds
Able to tolerate spontaneous ventilation without excessive tachypnea, tachycardia, or obvious respiratory distress

Question 7

Objective criteria for extubation: Vital signs

Answer 7

RR: <30-35 breaths/min
Stable BP with little to no ionotropic support
HR <140 bpm
Afebrile (temp <38)

Question 8

Objective criteria for extubation: ABG

Answer 8

ABG on 40% FiO2 and PEEP less thanor equal to  (5-10) 
PaO2 >60 
PaCO2 <55 
PaO2/FiO2 ratio >150-300 (200) 
AA gradient <350 
Maintenance of normal pH (>7.30)

Question 9

Objective criteria for extubation: Mechanincal function

Answer 9

FVC >10-15 
FEV 1 >10 
Tidal Volume >4-6 mL/kg 
NIF >20 
RSBI <60-100 

*adequate hemoglobin and obviously no significant respiratory acidosis

Question 10

Indications for intubation: mechanical function

Answer 10

RR >35
VC <15 mL/kg (adult)
VC <10 mL/kg (child)
NIF less than 20-25 cm

Question 11

Indications for intubation: gas exchange function

Answer 11

PaO2 <60%
PaCO2 >/ 55 unless chronically elevated
Dead space ventilation/tidal volume (Vd/Vt) ratio >/0.6 (normal 0.3)

Unstable vital signs

*obviously the inability of the patient to protect his airway secondary to agitation, airway burns, neuro injury