/ CHHS16/084

Canberra Hospital and Health Services

ClinicalProcedure

Cardiothoracic – post surgery extubation criteria (Adults)

Contents

Contents

Purpose

Alerts

Scope

Section 1 – criteria for extubation

Implementation

Related Policies, Procedures, Guidelines and Legislation

References

Search Terms

Purpose

This Procedure outlines the clinical criteria patients,who have undergone cardiothoracic surgery,are required to meet, prior to being extubated.

This Standard Operating Procedure (SOP) describes for staff the process to

Scope

Alerts

If the patient is receiving high dose Inotropes please consult the Medical Intensive Care Unit (ICU) team prior to extubation.

Please refer to the Extubation Standard Operating Procedure found on theCHHS Policy Register for information on how to extubate.

Scope

This document relates to patients who have undergone cardiothoracic surgery and are being cared for in the ICU.

This document applies to:

  • Medical Officers
  • Registered Nurses who are working within their scope of practice (Refer to Scope of Practice for Nurses and Midwives Policy)

Section 1 –criteria for extubation

Prior to extubation a Medical officer is to review the patient and to have recommended extubation.

Patients must meet the following criteria prior to extubation.

Neurological

The patient must be:

  • awake, cooperative, alert and orientated
  • able to lift his/her head off the pillow
  • able to move all limbs and obey simple verbal commands
  • pain controlled.
Respiratory

The patient must have:

  • adequate and equal chest movement / breath sounds.
  • Peak End Expiratory Pressure (PEEP)/Continuous Positive Airway Pressure (CPAP) 5 to 8mmHg
  • tidal volume 6-8 ml/kg
  • able to protect airway (cough, gag and swallow reflexes intact)
  • positive cuff leak test
  • minimal secretions
  • a strong, effective cough

Blood Gas Parameters

pH 7.35 7.45.[3]

PaCO2 <45mmHg

Pa02 > 70mgHg on 0.4 FIO2

HCO3 20 30mmol/L

BE5 to +5 mmol/L

O2 sat> 95%

Cardiovascular

The patient must have:

  • absent or only low dose inotrope/vasopressors (see Alert box)
  • a stable blood pressure in a sitting position
  • a stable cardiac rhythm
  • adequate perfusion.

Metabolic

The patient's temperature must be greater than 36° but less than 39°C.

Surgical

The patient must have:

  • less than 100ml per hour draining from intercostal drain, and/or
  • no evidence of tamponade.

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Implementation

This guideline will be implemented and communicated to the Intensive Care staff and incorporated into existing training programs, orientation plans and staff communicationfolder.

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Related Policies, Procedures, Guidelines and Legislation

Policies

Extubation Standard Operating Procedure

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References

  1. Elliot D, Aitken L, Chaboyer W. ACCN’s Critical Care Nursing. Australia: Elsevier; 2010.
  2. Seely A, Bravi A, Herry C, Green G, Longtin A, Ramsay T, et al. Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients? Critical Care [internet]. 2014 [Cited 2014 April 8]; 18(2). Available from BioMed Central.
  3. Alia I, Esteban A. Weaning from mechanical ventilation. Critical Care [internet].2000 [Cited 2000 Feb 18];4(2)72-80.Available from Bio Med Central.
  4. Thille A,Cortes-Puch I, Esteban A. Weaning from the ventilator and extubation in ICU review.[internet].2013[Cited2013 Feb];19(1)57-64.

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Search Terms

Cardiac Extubation

Extubation

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Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended / Section Amended / Approved By
Eg: 23 February 2016 / Section 1 / ED/CHHSPC Chair
Doc Number / Version / Issued / Review Date / Area Responsible / Page
CHHS16/084 / 1 / 24/06/2016 / 01/07/2018 / Critical Care – Intensive Care Unit / 1 of 4
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register