What is extubation?
What is done?
Once your loved one is ready to be taken off the ventilator(Ventilators (Breathing Machines) after your loved one has gone through a ‘weaning’ process. Weaning means gradually reducing the support the ventilator is providing to your loved one, until minimal parameters have been reached so that your loved one can breath by him or herself. The weaning period can be relatively quick, within few hours after admission to Intensive Care or it can be very slow, sometimes over many days, depending on circumstances. Before extubation your loved one has been deemed ready for extubation by the doctor and the nurse. Other factors that need to be present before your loved one can be extubated are
- awake and cooperative
- adequate oxygenation
- adequate ABG(Arterial Blood Gas)
- sitting up in bed
- presence of spontaneous cough
Prior to taking the Breathing Tube or Endotracheal Tube out the bedside nurse will explain the extubation procedure to your loved one. Usually what happens is that before the tube is removed, the nurse will suction down the breathing tube, in order to clear any sputum or secretions that may stop your loved one from breathing after extubation. Then another suction is required, this time in your loved ones mouth in order to clear any secretions there. Lastly the Breathing tube’s cuff(air balloon) in your loved ones trachea(wind pipe) is taken down and the tube is removed. During extubation your loved one may feel and look uncomfortable and he or she will cough while the tube is taken out. The whole procedure is quick and only takes a couple of minutes. After extubation an oxygen mask will be applied to assist your loved one breathing spontaneously. Your loved one remains closely monitored(Bedside Monitors) in order to manage a successful process after extubation. In some circumstances after extubation, application of an oxygen mask may not be sufficient and BIPAP or Non- Invasive Ventilation(NIV) may have to be commenced.
Your loved one may have difficulties talking at first and he or she may have a hoarse voice.
In some cases and after it has been confirmed that a Patient is approaching their end of Life the tube will be removed. Once the tube has been removed, the Patient may die quickly within minutes, but sometimes this may take hours to days. This will only be done after discussion with the Family and after views have been discussed of what is in the best interest of your loved one. This is done to enhance your loved ones dignity during this difficult time.
If the Patient dies and there will be a coroner’s case the breathing tube must remain in.
What are the risks?
It is uncommon to have problem after extubation, however some Patients have difficulty breathing once extubated. If your loved one has difficulties after being extubated, it usually comes down to a number of reasons such as
- airway swelling
- breathing muscle weakness
- lung infection
Usually treatment of choice are
- nebulising medication to mobilise secretions and sputum
- physiotherapy and suctioning
- BIPAP or Non- Invasive Ventilation(NIV
- A small number of Patients however will need to be re-intubated (re-insertion of a Breathing Tube or Endotracheal Tube) and placed back on the ventilator (Ventilators (Breathing Machines)
Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors.
All Intensive Care procedures carry a degree of risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for your loved one and of course, if you have any questions or concerns, please ask the ICU nurses and doctors.
The information contained on this page is general in nature and therefore cannot reflect individual Patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. INTENSIVE CARE HOTLINE attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual Patient. Please refer to the full disclaimer.