Indications for intubation and extubation Flashcards
What is the sniffing position?
Flexion of neck, extension of head
When intubating-always confirm
Presence of suction and free flowing IV line
What is FVC?
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
FEV:
How much a person can exhale in one breath
RSBI:
Frequecy/tidal volume (<60-100 breaths/min)
Subjective criteria for extubtion:
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
Objective criteria for extubation: Vital signs
RR: <30-35 breaths/min
Stable BP with little to no ionotropic support
HR <140 bpm
Afebrile (temp <38)
Objective criteria for extubation: ABG
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)
Objective criteria for extubation: Mechanincal function
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
Indications for intubation: mechanical function
RR >35
VC <15 mL/kg (adult)
VC <10 mL/kg (child)
NIF less than 20-25 cm
Indications for intubation: gas exchange function
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