Assessing extubation criteria, and then deciding when to extubate a patient safely can sometimes be a difficult decision.
We all know the common extubation criteria:
- recovery of airway reflexes and response to command;
- inspiratory capacity of at least 15 ml/kg;
- no hypoxia, hypercarbia, or major acid/base imbalance;
- no cardiopulmonary instability;
- signs of intact muscle power;
- absence of retraction during spontaneous respiration;
- absence of a distended stomach.
In other words, you want your patient to be stable, able to breathe without help, and able to protect the airway.
However, sometimes the decision is not so easy. Here I describe a case of a patient who met some but not all of the criteria for extubation. The reason turned out to be due to a rare complication: plugging of the endotracheal tube. However, getting to that solution required working through the extubation algorithm. Continue reading