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Related Concept Videos

Endotracheal Tube Extubation01:24

Endotracheal Tube Extubation

Endotracheal tube extubation is a critical procedure in weaning patients from mechanical ventilation. It involves physically removing the oral or nasal endotracheal (ET) tube, marking the final step in liberating a patient from ventilatory support.
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals.
Endotracheal Intubation II: Nursing Management01:17

Endotracheal Intubation II: Nursing Management

Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
Endotracheal Intubation I: Procedure01:15

Endotracheal Intubation I: Procedure

Endotracheal or ET intubation is a critical medical procedure used to secure a patient's airway, often in acute respiratory distress, apnea, upper airway obstruction, ineffective clearance of secretions, high risk for aspiration, or during general anesthesia.
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
Acute Respiratory Failure-II01:21

Acute Respiratory Failure-II

Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
Acute Respiratory Failure-III01:30

Acute Respiratory Failure-III

Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without causing...
Tracheostomy Decannulation01:21

Tracheostomy Decannulation

Tracheostomy decannulation is a significant milestone in the liberation of mechanically ventilated patients. Despite its importance, there is no universally accepted protocol for this procedure. This demands an evidence-based, individualized approach.
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...

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A Structured Approach to Extubation in Mechanically Ventilated Rats
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Published on: July 18, 2025

Failed extubation in the neonatal intensive care unit.

Kevin D Pereira1, Stacey L Smith, Marion Henry

  • 1Department of Otolaryngology-Head and Neck Surgery, The University of Texas, Medical School at Houston, Houston, TX, United States. kevindpereira@gmail.com

International Journal of Pediatric Otorhinolaryngology
|September 14, 2007
PubMed
Summary

Premature infants with chronic lung disease and low birth weight are more likely to experience failed extubation and require airway intervention, such as a tracheostomy. Abnormal airway findings are common in these neonates.

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Published on: January 17, 2011

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Otolaryngology

Background:

  • Failed extubation in Neonatal Intensive Care Units (NICU) necessitates airway intervention.
  • Understanding the causes of failed extubation is crucial for improving patient outcomes.

Purpose of the Study:

  • To identify the causes of failed extubation in premature infants.
  • To determine the need for airway intervention, including tracheostomy, following failed extubation.

Main Methods:

  • Retrospective chart review of premature infants (<37 weeks gestational age) admitted to a tertiary care children's hospital.
  • Direct laryngoscopy and bronchoscopy (DLB) were performed on 63 patients to evaluate failed extubation.
  • Data collected included gestational age, birth weight, co-morbidities, extubation history, DLB findings, and tracheostomy status.

Main Results:

  • Fifty patients (Group A) underwent tracheostomy, with an average gestational age of 30.0 weeks and birth weight of 1457g.
  • Thirteen patients (Group B) did not undergo tracheostomy, with an average gestational age of 34.5 weeks and birth weight of 2309g.
  • Subglottic stenosis was found in 44% of Group A and 23.1% of Group B; chronic lung disease was present in 56.0% of Group A and 38.5% of Group B.

Conclusions:

  • Abnormal laryngotracheal findings are frequent in neonates with failed extubation.
  • Neonates with chronic lung disease, gestational age ≤30 weeks, and low birth weight are at higher risk for subglottic edema and failed extubation.
  • These high-risk neonates are more likely to require tracheostomy for airway management.