Extubation and Decannulation Weaning

Question 1

What is the difference between extubation and decannulation?

Answer 1

1. Extubation is the process of removing an artificial tracheal airway
2. Decannulation is the process of removing a tracheostomy tube

Question 2

When is extubation and decannulation done a patient?

Answer 2

On patients who are not being mechanically ventilated?

Question 3

Criteria for weaning patient for Extubation and Decannulation?

Answer 3

• Patient is hemodynamically and clinically stable
• Vent support reason is resolved/improved
• Can protect airway aka can manage oral secretions
• Adequate cough
• Is there a condition that required airway support

Question 4

How do you assess adequate cough and gag reflex?

Answer 4

Suction

Question 5

When is weaning assesment performed?

Answer 5

Prior to actual process of weaning

Question 6

How do you know if a patient is clinically stable?

Answer 6

Patient has adequate CNS function

• Can maintain stable ventilatory drive
• Has adequate cough and can manage oral secretions
• Good LOC and little or no dyspnea

Question 7

What oxygenation goals do we aim for when considering extubation/decannulation?

Answer 7

• FiO2 < 0.5 w/decent PaO2
• Good P/F Ratio (>300)

Question 8

What does it mean when a patient can protect their airway?

Answer 8

Minimal risk for upper airway obstruction

• LOC (GCS>8)
• Able to manage oral secretions
• Intact cough reflex
• Positive cuff leak test

Question 9

What does a cuff leak test generally entail?

(4 steps)

Answer 9

Question 10

How long does feeding need to be d/c’d before extubation?

Answer 10

feeding/feed tubs should be d/c atleast 4-6hrs before extubation

Question 11

How long should successful SBT trial run for?

Answer 11

30-120 mins

Question 12

What should you check when monitoring a SBT trial?

Answer 12

Resolution of their disease state or condition

• Hemodynamic stability
• Adequate oxygenation
• Low FiO2
• PEEP
• Adequate ventilatory status
• PaCO2
• Normal pH

Question 13

What equipment should you have for extubation?

Answer 13

Question 14

What vital signs should you watch when extuabting?

Answer 14

Watch for signs of Oxygenation Failure and Ventilation failure

• ↓ SpO2, ↑ FiO2
• ↑ WOB
• ↑ Accessory muscle use
• ↑ Dyspnea
• ↓ LOC

Question 15

What is considered a successful extubation?

Answer 15

If patient is able to remain extubated for 24 hours

• If patient deteriorates or requires reintubation before 24 hrs has elapsed, patient has failed extubation.

Question 16

What does stridor indicate after extubation?

Answer 16

Laryngeal edema or obstruction, causes could be from:

• Smoke inhalation
• Epiglottitis
• Angioedema (dermal, subcutaneous or submucosal edema of the face or larynx)

Question 17

What could airway compression be caused by post extubation?

Answer 17

• Tumor/abscess
• Trauma
• Post op head, neck, or oral surgeries

Question 18

Aside from reintubation, how could stridor be managed post extubation?

Answer 18

• Cool aerosol with supplemental O2
• Tx with nebulized 1:1000 epinephrine (5 mL)
• Tx with Heliox mixtures by NRBM

Question 19

What could increase risk of aspiration post extubation?

Answer 19

If the Laryngeal reflexes are incompetent’s or deficit post extubation

• common when there is imparied cough

Question 20

What is Odynophagia?

Answer 20

Painful swallowing or talking; could cause glottic infection or ulceration

Question 21

How are Trach’s weaned?

Answer 21

Make pt breathe on their own via:

• Using progressively smaller tubes
• Tracheal buttons
• Fenustrated trachs

Question 22

Criteria for Decannulation of Trach?

Answer 22

Corked for 24h

• able to manage secretions
• pulmonary secretion’s not copious
• able to cough effectively and clear pulmonary secretions

Question 23

Equipment for decannulation

Answer 23

Question 24

What position should a patient being extubated or decannulated?

Answer 24

Semi or high fowlers if possible