Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So yesterday I had a question from a reader, Sherry and Sherry asks, what should we expect after extubation?
So to give you a little bit of context, Sherry’s father has been in intensive care now for about 10 days with the pneumonia, and he’s finally ready for extubation. He’s been intubated for about 10 days after pneumonia and induced coma. And now he’s coming out of the induced coma. The pneumonia has slowly cleared up and he’s now ready for extubation.
So just to give some definitions here, extubation stands for removal of the breathing tube. The breathing tube is in the mouth also known as an endotracheal tube.
So what should you expect after extubation?
Look, it really depends on how long a critically ill patient has been intubated for. Intubation again means the insertion of a breathing tube or an endotracheal tube. So how long, what should you expect?
So what you should expect, if it’s short term ventilation, like let’s just say less than 72 hours, you should have your loved one awake, breathing by themselves with a little bit of oxygen support and they should get mobilized.
They should get chest physical therapy or just physiotherapy. They should do some breathing exercises. They might need a little bit of oxygen. They might need some nebulizers to mobilize secretions. It’s very important that your loved one has a good, strong cough that they can clear their airway.
Now, after about 10 days of ventilation and induced coma, things might be a little bit trickier because that’s sort of a prolonged induced coma. It might take more time for your father to wake up.
He might not be coherent straight away, but he might be able to maintain a stable airway. What might happen depending on the overall situation, what you might be able to expect is, I talked about needing oxygen to breathe independently without a ventilator, but sometimes patients might even need a little bit of BiPAP or CPAP with a mask to support keeping the airway open and not having the lungs collapsed again.
Another thing that can happen after prolonged intubation and ventilation and induced coma is obviously a confusion aspect. So sometimes patients can be confused. They can be agitated because that’s a side effect of the induced coma and all the drugs that have been given during the induced coma. So those could be side effects too.
But what’s really critically important after extubation is deep breathing exercises. It is important, mobilization, getting out of bed, getting in a chair that is so critically important because that’s when you can actually expand your lungs.
And that’s what will help keeping the lungs open, keeping the airway open, good, strong cough, walking, talking, hopefully patients can start to eat and drink not straight away because the aspiration risk especially right after extubation is fairly high. So you wouldn’t want to eat and drink straight away. But within sort of 24 to 48 hour, you should be able to take in some oral nutrition, some water, some tea, start with some light stuff.
Other things you can expect after extubation is for example, a hoarse voice. So the vocal chords during intubation might get damaged a little bit and it might be difficult for patients to talk right away after extubation.
So those are the main issues or main things to look for and what you should expect after extubation. Obviously there’s always a risk for reintubation that if extubation fails and I would argue from experience, the longer somebody has been intubated and ventilated with a breathing tube, the risk for failure of extubation is definitely there.
And again, keeps coming back to mobilization, deep breathing exercises, nebulizers and oxygen therapy. I can’t stress those issues enough. And another thing that you should be looking for, no more sedation, because sedation might make people too drowsy. And if they’re too drowsy, they might stop breathing and you wouldn’t certainly want that for somebody that’s just been freshly extubated.
So I hope that helps for today. That’s my quick tip.
This is Patrik Hutzel from intensivecarehotline.com. Like this video comment down below what questions that you have and to subscribe to our YouTube channel for tips for families in intensive care.