View
25
Download
0
Category
Preview:
Citation preview
STEP I Screen
Passed SBT
SAT Done
Tracheal suction <q2h
Minimal oral secretions
Spontaneous cough
Cuff leak
�1
SBT=Spontaneous Breathing Trial; SAT=Spontaneous Awakening Trial
!
If yes to any of the screening items, patient automatically classified as
High Risk - Delayed Failure.
If all criteria met, STOP - proceed to routine extubation.
Screen failure in any of the criteria place patient in categories above
Low Risk.
STEP II Assess
C-Spine Surgery (>3 levels + operative time > 5 hrs or blood loss >300 mL)
Restricted Airway Access
Cervical Immobility/Instability
History of Difficult Airway
BMI >40kg/m2
�2
Any Of The Following:
STEP II Assess
�3
>2 Of The Following:
Age >60 years
Male Gender
Coma (GCS <10)
Chronic Lung Disease
Positive Cardiac History
!
!
!
End Stage Kidney Disease
Tracheal Suctioning >q2h
Frequent oral suctioning
Failed >3 previous SBTs
STEP III Prepare
Difficult Airway Cart: at bedside
Notify Anesthesia Airway Pager
Allow Continuous Airway Access
Hold Feeds: 2h pre- & 6h post-extubation
Insulin Treated Patients: initiate dextrose
Recommend: methylprednisolone 20mg IV q4h; 3 doses prior to extubation
�4
HIGH RISK: Immediate FailureImmediate post-extubation respiratory distress requiring reintubation w/in 2hrs of extubation.
STEP III Prepare
�5
HIGH RISK: Delayed FailurePost-extubation respiratory distress requiring reintubation up to 24-48 hrs after extubation
Backup Plan Notify ICU Team Consider ABG/VBG q12 h
Respiratory Therapist Assess 4h post-extubation Bronchial Hygiene Protocol (if indicated)
STEP III Prepare
�6
LOW RISK
Routine extubation
STEP III: PrepareClear communication among teams, observation & monitoring
Resume feeds after succesful intubation
If reintubation, prepare smaller size endotracheal tube
�7
STEP IV Extubate
Recommended