Extubation

What is extubation?

The removal of the Breathing Tube or Endotracheal Tube after Intubation of the larynx or trachea(wind pipe). The purpose of extubation in Intensive Care is to take the Patient off mechanical ventilation(Ventilators (Breathing Machines) so that he or she is able to breathe on their own.

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 after extubation.

Also, sometimes your critically ill loved one may not have “woken up” fully to be ready for extubation and that may cause a delay. Check out this article/video here if your critically ill loved one hasn’t “woken up”.

HOW LONG DOES IT TAKE TO WAKE UP AFTER AN INDUCED COMA?

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)

Any Questions?

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.

How can you have PEACE OF MIND, control, power and influence whilst your loved one is critically ill in Intensive Care?

You get to that all important feeling of PEACE OF MIND, CONTROL, POWER AND INFLUENCE when you download your FREE “INSTANT IMPACT” report NOW by entering your email below! In Your FREE “INSTANT IMPACT” report you’ll learn quickly how to get PEACE OF MIND, real power and real control and how you can influence decision making fast, whilst your loved one is critically ill in Intensive Care! Your FREE “INSTANT IMPACT” Report gives you in-depth insight that you must know whilst your loved one is critically ill or is even dying in Intensive Care! Sign up and download your FREE “INSTANT IMPACT” REPORT now by entering your email below!

In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care!

In your FREE reports you’ll also discover

How to ask the doctors and the nurses the right questions
Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
5 “killer” tips& strategies helping you to get on the right path to PEACE OF MIND, control, power and influence in your situation
You’ll get real world examples that you can easily adapt to your and your critically ill loved one’s situation
How to stop being intimidated by the Intensive Care team and how you will be seen as equals
You’ll get crucial ‘BEHIND THE SCENES’ insight so that you know and understand what is really happening in Intensive Care
How you need to manage doctors and nurses in Intensive Care(it’s not what you think)

Make sure you also check out our “blog” section for tips& strategies and also check out our “your questions answered” section where we answer your questions or send me an email to [email protected] with your questions!

Sincerely, your Friend
Patrik Hutzel