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EXTUBATION Dr Farhan Shaikh Consultant pediatric Intensisvist Rainbow Children’s Hospital
[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Assessment of Extubation Readiness
[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],AGE GOAL RANGE Under 6 months 20 to 60 breathes/min 6 months to 2 years 15 to 45 breaths/min 2 to 5 years 15 to 40 breaths/min Over 5 years 10 to 35 breaths/min
Precautions  ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
EQUIPMENT AND MATERIALS  ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Procedure ,[object Object],[object Object]
[object Object],Deflate the cuff or cut the pilot balloon.  Ask the patient to take a deep breath and to cough, apply vacuum, and at the peak of inspiratory effort,  rapidly remove the tube.  Administer humidified oxygen therapy.  Continue to evaluate the patient post extubation  for signs of respiratory compromise.
POST PROCEDURE  ,[object Object],[object Object],[object Object],[object Object]
Possible post extubation problems ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Post Extubation Stridor ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How to predict post extubation stridor? ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object]
Treatment of Stridor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fiberoptic bronchoscopy  ,[object Object],[object Object],[object Object]
Extubation failure ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Effects of extubation failure on patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Excessive resp effort 42% Poor resp effort 24% Inadequate gas exchange 18% Cardiovasc insufficiency 10% Neurologic 6%
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Avoiding Extubation failure ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
NIV ,[object Object],[object Object],[object Object]
NIV ,[object Object],[object Object],[object Object]
Tracheostomy ,[object Object]
Summary ,[object Object],[object Object]
[object Object],[object Object]
Quality standards for Extubation ,[object Object],[object Object],[object Object],[object Object]
THANK YOU

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Extubation

  • 1. EXTUBATION Dr Farhan Shaikh Consultant pediatric Intensisvist Rainbow Children’s Hospital
  • 2.
  • 3.
  • 4.
  • 6.
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Editor's Notes

  1. Experimental, autopsy and clinical studies show that prolonged intubation can lead to edema, inflammation and ulceration esp. at the level of the cords and at the cuff site 21/39(54%) intubated patientrs had ulcers on the posterior vocal cords and 49/52 (93%) had mucosal inflammation and/or edema at autopsy 15
  2. One of the most frequent complications following tracheal extubation Incidence 2-22% of patients intubated >24 hrs 1,2 Increases mortality rate and prolongs ICU stay3,4,5 Typically occurs shortly after extubation6,7,8 Usually occurs after 36 hrs of intubation6 One of the main causes of resp distress after extubation3 In a series of 700 consecutive extubations, 5 percent developed clinically significant laryngeal edema. However, only 1 percent of patients required reintubation, all of whom had been intubated for more than 36 hours (Darmon)
  3. Heliox Normal laminar flow is dependent on gas viscosity; when airway obstruction is present, flow is turbulent Turbulent air flow is dependent on gas density Heliox has a density 1/3 of oxygen or air so it decreases airway resistance and improves ventilation