Weaning and Extubation

Abstract

nursing staff in the ICU. Definition Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube (ET). Time spent in the weaning process typically represents 4050% of the total duration of mechanical ventilation (Boles et al, 2007). Nurses are required to assess the patient’s readiness to wean against a number of prerequisites (Crocker, 2009). Responsibilities This Guideline applies to all medical respiratory therapy and nursing staff working in the ICU. Procedure The respiratory therapist, nursing and medical team decide collaboratively if the patient is ready for weaning. Weaning Process: Assessment Criteria The timing of extubation should be carried out when the patient has reached the below assessment criteria. The pace of weaning should be determined by clinical assessment. Keep the respiratory therapist, charge nurse and medical team informed and in agreement on the patient’s weaning and extubation plan. Neurological a) Sedation is discontinued b) Patient is awake, alert and orientated, able to move all limbs, obeying commands. Patient should have GCS of >8. c) Pain is well controlled, intravenous analgesia may continue providing all neurological criteria are met d) Patient is educated on the extubation process Respiratory a) The patient’s breathing is unlabored, equal air entry, not using accessory muscles, respiratory rate normal, spontaneous breathing INDEX 95%. P/F ratio >200 c) Acid/base balanced, Arterial blood gas (ABG) acceptable for the patient, nebulizers administered if required d) Gag/cough reflex present on suctioning/ able to protect airway, secretions are acceptable e) Check in the patient’s medical notes that intubation was not difficult f) Perform leak test to determine if patient has laryngeal oedema. g) All Criteria has been met following spontaneous breathing trial. (SBT) Cardiovascular a) The patient is haemo dynamically stable, maintaining adequate mean arterial pressure (MAP), minimal isotropic support b) Hemoglobin >7 c) Minimal chest drain output d) No significant ECG changes. Extubation 1. Ensure the patient is sitting upright in the bed unless contraindicated by patient’s condition. 2. Ensure bedside emergency equipment is available and in working order, including re-intubation equipment. 3. The extubation procedure is a two person procedure Respiratory therapist/nurse 4. Prepare equipment required for extubation: a. Suction equipment including yankeur suction and suction catheters b. 60% FIO2 Face Mask oxygen supply and equipment to deliver humidified oxygen c. 10 ml syringe