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Endotracheal Tube Extubation01:24

Endotracheal Tube Extubation

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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....
439
Endotracheal Intubation II: Nursing Management01:17

Endotracheal Intubation II: Nursing Management

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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...
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Endotracheal Intubation I: Procedure01:15

Endotracheal Intubation I: Procedure

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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...
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Tracheostomy Decannulation01:21

Tracheostomy Decannulation

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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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Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques01:30

Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques

1
Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway...
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Pneumonia V: Nursing management and Prevention01:30

Pneumonia V: Nursing management and Prevention

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Nursing management of pneumonia involves promoting airway patency, facilitating rest and conserving energy, encouraging fluid intake, maintaining nutrition, and educating patients.
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
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Updated: Jun 9, 2025

An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
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Multidisciplinary Lessons from Palliative Extubations at Home.

Amelia M Breyre1, Megan Grammatico2, Alexa Policastro1

  • 1Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.

Prehospital Emergency Care
|October 30, 2024
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Summary

Most critically ill patients wish to die at home, but mechanical ventilation poses challenges. This study shows successful home palliative extubation is possible, offering patient-centered care.

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Area of Science:

  • Medical Sciences
  • Critical Care Medicine
  • Palliative Care

Background:

  • Most patients with serious illness prefer to die at home.
  • Mechanical ventilation often prevents patients from achieving this preference due to complex care requirements.
  • Palliative extubation at home for ventilated patients is rarely documented.

Purpose of the Study:

  • To present successful cases of home palliative extubation for mechanically ventilated patients.
  • To explore the challenges and solutions for facilitating home death for these patients.
  • To provide a framework for enabling patient choice in end-of-life care.

Main Methods:

  • Case report of two patients undergoing home palliative extubation.
  • Multidisciplinary team coordination including critical care, palliative care, care management, hospice, and emergency medical services (EMS).
  • Analysis of operational and regulatory challenges encountered.

Main Results:

  • Successful palliative extubation and home death were achieved in both presented cases.
  • Effective coordination among diverse healthcare professionals was crucial for success.
  • Key challenges included logistical, regulatory, and clinical support at home.

Conclusions:

  • Home palliative extubation is feasible for select mechanically ventilated patients.
  • A coordinated multidisciplinary approach is essential for successful implementation.
  • This model supports patient-centered care and honors end-of-life preferences.