Intubation/Extubation criteria?

Started by lymanite37
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lymanite37

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I'm an MS-III doing an anesthesia rotation. The doctor I was working with yesterday asked me to research and present to him the criteria for intubation/extubation. I've looked and can't really find anything official. I'm guessing he wants me to tell him what I should see on the monitors and from the pt. before I attempt to intubate/extubate. Is there an official list of criteria for this? Thanks.
 
lymanite37 said:
I'm an MS-III doing an anesthesia rotation. The doctor I was working with yesterday asked me to research and present to him the criteria for intubation/extubation. I've looked and can't really find anything official. I'm guessing he wants me to tell him what I should see on the monitors and from the pt. before I attempt to intubate/extubate. Is there an official list of criteria for this? Thanks.
Click to expand...

Almost any critical care textbook will have a chapter about these issues. For extubation, be sure to include objective indices such as the Rapid Shallow Breathing Index (the other RSI), NIF and other "mechanics", etc...
 
lymanite37 said:
I'm an MS-III doing an anesthesia rotation. The doctor I was working with yesterday asked me to research and present to him the criteria for intubation/extubation. I've looked and can't really find anything official. I'm guessing he wants me to tell him what I should see on the monitors and from the pt. before I attempt to intubate/extubate. Is there an official list of criteria for this? Thanks.
Click to expand...

other than "I think he'll be ok" make sure:
1) patient spontaneously ventilating
2) reversed adequately: sustained tetany w/o fade > 5 sec is one way to do it.
3) vital signs stable
4) not in stage 2

Book stuff:

RSBI < 100. Respiration rate/tidal volume in Liters.

nif <-20mmhg (you can take off bag and cover hole with hand and have patient suck in while watching pressure gauge

leak test for airway surgeries/long prone case (dunno how useful it is in reality)

TV >10cc/kg
VC > 15cc/kg
Spo2 > 90% with fio2 <40%
RR <35
paco2 <45

something about dead space which I aint calculating in the OR and something about shunt being less than 15%...again, I ain't calculating it. A-a gradient can also be used in some capacity.

You can always ask the patient...
 
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