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Endotracheal Tube Extubation

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 Management

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: Procedure

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...

Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen

Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen

Oxygen therapy is a pivotal aspect of medical care, particularly for patients with respiratory ailments. Two prominent oxygen-delivering systems include the Venturi mask and the transtracheal oxygen catheter.
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...

Tracheostomy Decannulation

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...

Suctioning the Oropharyngeal Airway

Suctioning the Oropharyngeal Airway

In preparing for oropharyngeal airway suctioning, a nurse must gather all necessary equipment, including a suction unit with tubing, a prepackaged suction kit, sterile gloves, water or saline for irrigation, a water-soluble lubricant, and additional personal protective equipment (such as a gown, mask, and goggles) to control infections.
After assembling the equipment, the nurse should practice hand hygiene and don appropriate PPE according to infection control guidelines to avoid the...

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Related Experiment Video

Updated: Mar 27, 2026

A Structured Approach to Extubation in Mechanically Ventilated Rats

A Structured Approach to Extubation in Mechanically Ventilated Rats

Published on: July 18, 2025

Identifying Patients at Risk for Unplanned Extubation in a Pediatric ICU.

Cheryl Dominick¹, Laura Oldehoff², Amanda Rolfe¹

¹Ms. Dominick, Ms. Rolfe, Mr. Griffin, and Mr. Alemayehu are affiliated with Department of Respiratory Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Respiratory Care

|March 26, 2026

Summary

This summary is machine-generated.

A new Unplanned Extubation Risk Assessment Scoring (UERAS) tool showed high reliability and was linked to fewer unplanned extubations in a pediatric ICU. This tool helps identify high-risk patients for intervention, reducing adverse events.

Keywords:

airway extubation critical care intubation pediatric ICU pediatrics risk assessment risk factors unplanned extubation

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Area of Science:

Pediatric Critical Care Medicine
Patient Safety
Clinical Risk Assessment

Background:

Unplanned extubation (UE) in pediatric ICUs is a significant risk, leading to instability and re-intubation.
Developing a reliable risk assessment tool is crucial for mitigating UE.
The Unplanned Extubation Risk Assessment Scoring (UERAS) tool was created to address this need.

Purpose of the Study:

To develop and validate the UERAS tool for identifying patients at high risk of UE.
To assess the inter-rater reliability (IRR) of the UERAS.
To determine if UERAS implementation reduces UE events in a pediatric ICU.

Main Methods:

The UERAS tool, with scores ranging from 0-18 (≥6 high risk), was developed and piloted in a 75-bed pediatric ICU.
Inter-rater reliability was established among respiratory therapists (RTs).
Standardized mitigation strategies, including electronic alerts and bedside huddles, were implemented for high-risk patients.

Main Results:

The UERAS demonstrated high IRR (Pearson's correlation coefficient 0.997).
Implementation of UERAS and mitigation actions was associated with a significant reduction in UE events (0.44 to 0.14 per 100 ventilator days).
The tool showed limited predictive efficacy for individual UE events, with some UEs occurring in low-risk patients.

Conclusions:

The UERAS tool exhibits high inter-rater reliability.
Implementing the UERAS tool alongside targeted mitigation strategies is associated with a decrease in unplanned extubation events in the pediatric ICU.