Vent-Extubation

Question 1

Important Questions in Regards to Extubation

Answer 1

• Is patient getting better?
• Is initial reason for providing ventilatory support resolved or improved?
• Does the patient requires minimal ventilatory support
• Is patient clinically stable?
• Is there any impending condition that might require airway support?
• Is patient able to protect airway/ Manage oral secretions
• Is patient requiring minimal suctioning/Adequate cough

Question 2

Clinically Stable-CNS and Psychological Factors

Answer 2

Adequate CNS function needed to maintain stable ventilatory drive, adequate cough and ability to manage oral secretions

LOC, anxiety, depression and dyspnea can all have an impact on weaning success

Question 3

Clinically Stable-Evaluation Of The Airway

Answer 3

Patient’s ability to maintain patent airway

Risk of aspiration

Question 4

Clinically Stable-Oxygenation

Answer 4

FiO2, PO2, lactic acidosis

P/F Ratio (>300)

Question 5

Clinically Stable-Ventilation and acid-base balance

Answer 5

pH, PCO2, VT, f spon, RSBI

Question 6

Clinically Stable

Answer 6

VC

Question 7

Clinically Stable-Respiratory Muscle Strength

Answer 7

MIP or NIF (-20cmH2O)

Question 8

Clinically Stable-WOB

Answer 8

thoracic cage movement , accessory muscle use, irregular ventilatory pattern during spontaneous breathing

Question 9

Clinically Stable-Stable vital signs and hemodynamic parameters

Answer 9

HR, BP, CO etc.

Question 10

Clinically Stable-Optimum nutritional status

Answer 10

functioning G.I. Tract

Question 11

When extubated you need to watch for signs of ventiatory failure whcih include

Answer 11

Decrease SpO2

Increase FiO2

Increase WOB

Decrease LOC