Extubation
Formal Definition
Removal of an endotracheal tube following successful resolution of the indication for mechanical ventilation; preceded by a spontaneous breathing trial (SBT) to assess readiness, assessment of the patient's ability to protect the airway, and confirmation of adequate secretion management; post-extubation high-flow nasal cannula or NIV can prevent reintubation in high-risk patients.
How It's Used on the Ward
"Extubated" or "pulled the tube" or "successfully weaned off the vent" — taking out the breathing tube when the patient is ready to breathe on their own.
Example
""Ventilator day 5 ARDS patient: passed 30-minute SBT on CPAP 5/PS 5, FiO2 40%, SpO2 97%, RR 16, no distress, following commands, strong cough. GCS 14, able to follow four-step commands. Extubated to high-flow nasal cannula 40L/50% FiO2. Monitoring closely for post-extubation stridor.""
Clinical Context
SBT criteria: FiO2 ≤50%, PEEP ≤8, patient awake and following commands, hemodynamically stable, minimal secretion burden, strong cough. SBT failure signs: RR >35, SpO2 <90%, HR change >20%, hypotension, distress, diaphoresis. Post-extubation stridor: occurs in 5-15% of intubated patients, particularly women and prolonged intubations; treat with racemic epinephrine nebulizer and IV steroids; may require reintubation. Extubation failure (need for reintubation within 48h): associated with 5-10x higher mortality — high-flow nasal cannula (HFNC) or NIV bridge reduces reintubation risk in high-risk patients. RSBI (rapid shallow breathing index) = RR/tidal volume (L); <105 predicts successful extubation.
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