Important Questions in Regards to Extubation
- 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
Clinically Stable-CNS and Psychological Factors
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
Clinically Stable-Evaluation Of The Airway
Patient’s ability to maintain patent airway
Risk of aspiration
FiO2, PO2, lactic acidosis
P/F Ratio (>300)
Clinically Stable-Ventilation and acid-base balance
pH, PCO2, VT, f spon, RSBI
Clinically Stable-Respiratory Muscle Strength
MIP or NIF (-20cmH2O)
thoracic cage movement , accessory muscle use, irregular ventilatory pattern during spontaneous breathing
Clinically Stable-Stable vital signs and hemodynamic parameters
HR, BP, CO etc.
Clinically Stable-Optimum nutritional status
functioning G.I. Tract
When extubated you need to watch for signs of ventiatory failure whcih include