Respiratory Care Therapeutics: Extubation

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Questions and Answers

What is the primary reason for having a patient breathe unassisted through the tube for a brief period before extubation?

To determine the need for reintubation

To assess the patency of the upper airway

To give an indication of pulmonary reserve (correct)

To ensure the patient can clear airway secretions

What is the minimum tidal volume required for a patient to be considered for extubation?

10 mL/kg

7 mL/kg

5 mL/kg (correct)

3 mL/kg

What is the term for the process of removing a tracheostomy tube?

Intubation

Extubation

Decannulation (correct)

Cannulation

What is the minimum maximum negative inspiratory pressure required for a patient to be considered for extubation?

-30 cm H2O Signup and view all the answers

Why should personnel be present who are trained in airway management skills during extubation?

In case of an emergency Signup and view all the answers

What is the minimum spontaneous exhaled minute ventilation required for a patient to be considered for extubation?

10 L/min Signup and view all the answers

What is the minimum thoracic compliance required for extubation?

25 ml/cm H2O Signup and view all the answers

What is the primary goal of a Spontaneous Breathing Trial (SBT)?

To assess the patient's ability to breathe spontaneously Signup and view all the answers

What is a common complication that may occur after extubation?

Laryngospasm Signup and view all the answers

Why should oral feedings be withheld after extubation?

To prevent aspiration Signup and view all the answers

What is the definition of extubation failure?

Reintubation due to airway problems within 48 hours Signup and view all the answers

What is the recommended duration of a Spontaneous Breathing Trial (SBT)?

30-120 minutes Signup and view all the answers

What is a potential cause of hypoxemia after extubation?

Development of post-obstruction pulmonary edema Signup and view all the answers

What is a risk factor for extubation failure?

Tracheal intubation > 48 h Signup and view all the answers

What is a consequence of a positive cuff-leak test?

Higher risk of upper airway obstruction Signup and view all the answers

What is a potential cause of hypercapnia after extubation?

Hypoventilation and Respiratory muscle weakness Signup and view all the answers

What is the definition of extubation failure?

The need for reintubation within 48 h after extubation Signup and view all the answers

What is a potential complication of extubation?

Pulmonary aspiration Signup and view all the answers

How is the cuff-leak test performed?

By measuring the difference between the expired tidal volume when the cuff is inflated and when deflated Signup and view all the answers

What is the result of a cuff-leak test with a leak less than 15%?

High risk of upper airway obstruction Signup and view all the answers

Study Notes

Extubation

Requires 2 people to perform, but in clinical situations, one person can perform extubation, who should be proficient in intubation.
Patient should breathe unassisted through the tube for a brief period before extubation to assess pulmonary reserve.
Patient should be physiologically monitored, and emergency equipment and personnel trained in airway management skills should be present.
Personnel should follow the institute infection control policy.

Definitions

Extubation: The process of removing an artificial tracheal airway (oral or nasal endotracheal airway).
Decannulation: Process of removing tracheostomy tube.

Assessing Patient Readiness for Extubation or Decannulation

Patient should meet established extubation readiness criteria, including:
- Original problem is no longer present.
- Quantity and thickness of secretions have decreased.
- Upper airway patency.
- Presence of intact gag reflex.
- Ability to clear airway secretions.
- Adequate respiratory muscle strength (Maximum negative inspiratory pressure > -30 cm H2O).
- Vital capacity > 10 ml/kg ideal body weight.
- Tidal Volume > 5 mL/kg.
- In adults, spontaneous exhaled minute ventilation < 10 L/min.
- Capacity to maintain appropriate pH (pH ≥ 7.25) and arterial partial pressure of CO2 during spontaneous ventilation.
- In adults, respiratory rate < 30 breaths/min during spontaneous breathing.
- Thoracic compliance > 25 ml/cm H2O.
- Work of breathing < 0.8 J/L.

Spontaneous Breathing Trial (SBT)

SBT should be performed for 30-120 minutes with low level of CPAP (or PEEP) (e.g., 5 cm H2O) or low level of pressure support (e.g., 5-7 cm H2O).
Patient should show improved gas exchange (ABG); PaO2 ≥ 60 mm Hg FiO2 ≤ 0.40 on PEEP ≤ 5 cm H2O.
Hemodynamic stability.
RSBI (rapid shallow breathing index): RR/Vt < 105.
Subjective comfort.

Post-Extubation Complications

Hoarseness, sore throat, and cough are common but benign complications.
Laryngospasm is a rare but serious complication that can occur after extubation.
Extubation failure is defined as reinsertion of the airway due to airway problems within 48 hours after extubation.
Hypoxemia and hypercapnia can occur after extubation due to various reasons.

Predicting Difficult Extubation

Cuff-leak test can predict difficult extubation.
A positive cuff-leak test (absence of leak or leak less than 15%) indicates a high risk of upper airway obstruction.

Risk Factors for Extubation Failure

Extubation failure means the need for reintubation within 48 h after extubation.
Risk factors include:
- Tracheal intubation > 48 h.
- Upper airway obstruction.
- Edema.
- Stridor and/or reintubation.
- Other factors that can lead to extubation failure.

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Description

Learn about the process of extubation, including the importance of having a proficient person present and the patient's unassisted breathing before removal of the tube.