Page 214 - Clinical Application of Mechanical Ventilation

180 Chapter 6

TABLE 6-10 General Criteria for Extubation

Criteria Methods of Assessment

Rapid shallow breathing index f/V less than 100/min/L
T
Blood gases Acceptable blood gases on F O less than 40% and
2
I
spontaneous minute ventilation less than 10 L/min
PaO /F O (P/F ratio) . 250 mm Hg
2
I
2
Ventilatory reserve Maximal inspiratory pressure . 220 cm H O
2
Vital capacity . 15 mL/kg
Cardiopulmonary assessment Absence of cardiopulmonary problems (e.g., CHF,
pulmonary edema, pneumonia, tachycardia,
arrhythmia, chest retractions, distended stomach)

(Data from Epstein, 1995; Listello et al., 1994; Whelan et al., 1994; White, 2002; Whitten, 1997.)
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If the patient has an adequate vital capacity and cough reflex, the cuff is deflated
completely and the ET tube is removed. Encourage the patient to breathe deeply
and cough, and use a Yankaur (rigid tonsil tip) suction device to remove excess secre-
tions in the patient’s oropharynx.
If the patient does not have an adequate vital capacity and cough reflex, the suc-
tion catheter may be left extending from the distal end of the ET tube and continu-
ous suction is applied while the ET tube is being removed. An alternate method is
to leave the suction catheter in the oropharynx with continuous suction while the
ET tube is being removed. Either method may be used to remove secretions from
the patient’s airway or oropharynx (Figure 6-21).

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Figure 6-21 Use of a flow-inflating manual resuscitator, suction catheter, and a syringe
during extubation.

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