Microsoft Word - Extubation Guideline

7/28/2019 Microsoft Word - Extubation Guideline

1/4

Trevor Mann Baby Unit

Standards Group/CB Date written: Sept 2007Review due: Sept 2010

1

PROTOCOL FOR CARE OF THE BABY UNDERGOING EXTUBATION FROM

MECHANICAL VENTILATION

RATIONALE

From the time a baby is started on mechanical ventilation, the aim is to wean and then

extubate. Failure of extubation and subsequent reintubation, may result in additional stress and

trauma to the baby. Therefore, extubation should be planned for the correct time and in

optimum conditions, when the baby and staff are fully prepared.

INDICATIONS

Early extubation is advised in the preterm baby due to the associated barotraumas and

the development of pulmonary morbidity including chronic lung disease (Steer et al

2004).

Baby requires:

inspired oxygen value of less than 40%

able to maintain a satisfactory blood gas at a low rate (eg. < 20 bpm)

in a low peak pressure (eg. < 15cm water)

to be clinically and metabolically stable

(Sinha & Donn 2000)

PRACTICE

1. Assess babys respiratory drive to see if adequate for extubation, aim to change the baby

onto a trigger mode, to increase their work of breathing.

2. Work with medical team to reduce mean airway pressure, to equivalent achievable CPAP

pressure.

3. Reduce sedation according to individual need.

4. Reintubation is related to poor respiratory drive, hypercarbia and apnoeic episodes.

Methylaxanthines (caffeine) have been used to minimise these complications (Steer et al.

2004). Administer loading dose of caffeine and aim for at lease 4 hours before extubation.Ensure they are prescribed a subsequent daily dose as per drug formulary.


2/4



2

5. Explain to parents that there is a risk that the extubation will fail and result in reintubation.

6. Time extubation away from changes of shifts or in the night.

7. Ensure a senior member of medical staff or ANNP able to perform reintubation, is available

at the time of extubation.8. Ensure reintubation drugs are prescribed.

9. A blood gas should be taken prior to extubation, to ensure gaseous exchange within

acceptable limits.

10. The baby should receive suctioning prior to extubation (see suction guideline).

11. Withhold feeding an hour prior to extubation, just before decompress the stomach via the

gastric tube.

12. Aim to do a nappy change prior to extubation, so the baby can be left undisturbed.13. If the baby is to be extubated onto CPAP, make a decision with the medical team which

type of CPAP device is to be used. Nasal continuous positive airway pressure (NCPAP)

appears to stabilise the upper airway, improve lung function and reduce apnoea, and may

therefore have a role in facilitating extubation in preterm babies (Davis & Henderson-Smart

2006). Remember not all babies are eligible for CPAP eg. Abdominal surgical babies due to

gaseous distension.

14. Measure for correct size hat and prongs and have them prepared.

15. Plug in CPAP machine, check function and turn on humidifier.

16. Prepare universal container and sterile scissors. Send ET tube tip for microscopy, culture

and sensitivity.

17. Extubating to CPAP must be a two person procedure. Hold CPAP prongs into babys nose

prior to removal of ET tube, so functional residual capacity is maintained.

18. CPAP pressure should be maintained at 6-8 cms water (De Paoli et al. 2003). Nursing

care should be aimed at maintaining the pressure (see CPAP guideline)

19. Try to obtain these pressures with good positioning and prong placement, rather than high

flow rates. Babies receiving high flow rates may be at risk of cochlear damage due to noise

transmission (Surenthiran et al. 2003)

20. Promote minimal handling by all staff and parents following extubation.

21. Aim to nurse prone (unless umbilical lines insitu). Babies with respiratory distress placed

prone have higher oxygen saturation levels and better respiratory mechanics (Dimitiou et al.

2002)


3/4



3

22. Babies can be fed following extubation. They should have an orogastric tube to avoid

occlusion of the nares.

23. Blood gas should be taken 1 hour following extubation, and subsequently assessed on an

individual basis.24. The baby should be assessed continually for signs of respiratory compromise following

extubation.

REFERENCES

Dimitriou, G., A. Greenough, L. Pink, A. McGhee, A. Hickey, G.F. Rafferty (2002)Effect of posture on oxygenation and respiratory muscle strength in convalescent infantsArch

Dis Child Fetal Neonatal Ed 86:F147-150.

Sinha, S.K., S.M. Donn (2000) Weaning from assisted ventilation: Art or Science?

Arch Dis Child Fetal Neonatal Ed 83:F64-70

Steer, P. and the Caffeine Collaborative Study Group Steering Group (2004) High Dose

Caffeine Citrate for Extubation of Preterm Infants: A Randomised Contolled TrialArch Dis Child

Fetal Neonatal Ed 89:F499-503

Surenthiran, S.S., K. Wilbraham, J. May, T.Chant, A.J.B Emmerson, V.E. Newton (2003) Noise

levels within the Ear and Post-nasal space in Neonates in Intensive CareArch Dis Child Fetal

Neonatal Ed 88:F315-318


4/4



4

Microsoft Word - Extubation Guideline

Documents

Transcript of Microsoft Word - Extubation Guideline