Prior To Extubation

Question 1

Physical assessment prior to extubation

Answer 1

Ask patient to squeeze hand ask patient to lift head ask patient to turn head side to side ask patient to cough ask patient to stick tongue out

Question 2

Cuff leak test prior to extubation

Answer 2

Assess the patient to ensure adequate breathing without mechanical ventilatory support
Suction the patient’s mouth and Airway
Deflate the endotracheal tube cuff
Briefly occlude the endotracheal tube and assess ventilation
Suspect laryngeal edema if the patient is unable to breathe around the occluded endotracheal tube with the cuff deflated

Question 3

Extubation criteria

Answer 3

Ensure that the patient does not require continued mechanical ventilation support
Ensure the adequate spontaneous ventilation is present
Ventilator weaning indices are positive
Upper Airway obstruction or Airway compromise is unlikely

Question 4

Factors to optimize prior to ventilation discontinuance

First Factor

Answer 4

Ensure adequate oxygenation example Pao2 Spo2 Sao2 Cao2 Do2

Tx anemia if present

Question 5

Factors to optimize prior to ventilator discontinuance

Second Factor

Answer 5

Provide adequate humidification
Insure secretion clearance by providing bronchial hygiene such as suctioning turning chest Physiotherapy
Provide bronchodilator to treat or prevent present bronchospasm
Avoid artificially hyperventilating the patient and creating a respiratory alkalosis
Reduce imposed work of breathing
Rest ventilatory muscles to avoid respiratory muscle fatigue or atrophy

Question 6

Factors to optimize prior to ventilator discontinuance

Third Factor

Answer 6

Assess acid-base balance and electrolytes
Treat metabolic acidosis ( kidney failure, lactic acidosis, ketoacidosis)
Treat metabolic alkalosis ( treat low potassium, low chloride, nasogastric tube HCI loss, vomiting)
Treat low phosphate or magnesium and any other electrolyte disorders

Question 7

Factors to optimize prior to ventilator discontinuance

Fourth Factor

Answer 7

Assess cardiovascular status
Maintain blood pressure and cardiac output
Treat arrhythmias if present
Optimize left ventricular function

Question 8

Factors to optimize prior to ventilator discontinuance

Fifth Factor

Answer 8

Assess renal function

Assess kidney function and fluid balance

Question 9

Factors to optimize prior to ventilator discontinuance

Sixth Factor

Answer 9

Treat fever, infection, or sepsis

Question 10

Factors to optimize prior to ventilator discontinuance

Seventh Factor

Answer 10

Minimize pain without oversedation

Question 11

Factors to optimize prior to ventilator discontinuance

Eighth Factor

Answer 11

Avoid sleep depravation

Question 12

Factors to optimize prior to ventilator discontinuance

Ninth Factor

Answer 12

Increase exercise tolerance such as in chair if possible

Question 13

Factors to optimize prior to ventilator discontinuance

Tenth Factor

Answer 13

Review medications that may affect ventilation
Narcotics, sedatives, tranquilizers, hypnotics
Aminoglycosides
Neuromuscular blocking agents

Question 14

Factors to optimize prior to ventilation discontinuance

11th Factor

Answer 14

Assess psychological status
Level of consciousness
Agitation anxiety
Motivation

Question 15

Factors to optimize prior to ventilator discontinuance

12th Factor

Answer 15

Assess for possible hypothyroidism

Question 16

Factors to optimize prior to ventilator discontinuance

13th Factor

Answer 16

Consider nutritional factors
Avoid overfeeding (increases CO2 production)
Adjust for malnutrition, protein loss
Consider high-fat, low carbohydrate diet to minimize CO2 production

Question 17

Factors to optimize prior to ventilator discontinuance

14th Factor

Answer 17

Assess gastrointestinal or abdominal factors
Bleeding or obstruction
Abdominal distension, ascites

Question 18

Factors to optimize prior to ventilator continuance

15th Factor

Answer 18

Optimize procedural factors
Time of day avoid evenings, nights, shift change
Ensure adequate Staffing
Avoid interruptions and distractions

Question 19

Factors to optimize prior to ventilator disturbance

16th Factor

Answer 19

Review technical factors
Compensate for endotracheal tube resistance
Assess intrinsic peep and use of Peep / CPAP to balance intrinsic peep