Consultant decision that a patient is ready for extubation.
Enteral feeds stopped at least four hours prior to planned extubation.
IV sedation stopped at least four hours prior to extubation. There may be exceptions - e.g. long term patients who have developed tolerance who are on a weaning programme.
The doctor performing the extubation must have a plan of how the patient will be reintubated if the patient fails extubation. If the doctor is not an anaesthetist, competent in managing a child of that age, the PICU consultant will need to be in the hospital at the time of extubation.
Immediately prior to extubation
- Aspirate NG tube
- Ensure all equipment ready:
Bag and mask
Calling the anaesthetist on bleep 6000 (or the adult ITU registrar with the event of them being busy) is for emergencies only.
A planned extubation which fails should not feel like an emergency situation.
Post extubation stridor
nebulised adrenaline 0.5ml/kg 1 in 1000 (max 5ml)
and dexamethasone 0.5mg/kg IV (max 10mg).
Prophylaxis against post extubation stridor
Used in patients with history of failed extubation due to upper airway obstruction, and in some ENT cases
Dexamethasone: 0.5mg/kg IV qds (max 10mg) Start 6 - 12 hours prior to extubation, up to 6 doses may be given.
A lower dose is sometimes given at Consultant's discretion.
Monitor glucose and BP carefully.