Cardiothoracic – post surgery extubation criteria (Adults)



Canberra Hospital and Health ServicesClinical Procedure Cardiothoracic – post surgery extubation criteria (Adults)Contents TOC \h \z \t "Heading 1,1" Contents PAGEREF _Toc453659579 \h 1Purpose PAGEREF _Toc453659580 \h 2Alerts PAGEREF _Toc453659581 \h 2Scope PAGEREF _Toc453659582 \h 2Section 1 – criteria for extubation PAGEREF _Toc453659583 \h 2Implementation PAGEREF _Toc453659584 \h 3Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc453659585 \h 4References PAGEREF _Toc453659586 \h 4Search Terms PAGEREF _Toc453659587 \h 4PurposeThis 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 ScopeAlertsIf 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 the CHHS Policy Register for information on how to extubate.ScopeThis document relates to patients who have undergone cardiothoracic surgery and are being cared for in the ICU.This document applies to:Medical OfficersRegistered Nurses who are working within their scope of practice (Refer to Scope of Practice for Nurses and Midwives Policy)Section 1 – criteria for extubationPrior to extubation a Medical officer is to review the patient and to have recommended extubation.Patients must meet the following criteria prior to extubation.?NeurologicalThe patient must be:awake, cooperative, alert and orientatedable to lift his/her head off the pillowable to move all limbs and obey simple verbal commandspain controlled.RespiratoryThe patient must have:adequate and equal chest movement / breath sounds.Peak End Expiratory Pressure (PEEP)/Continuous Positive Airway Pressure (CPAP) 5 to 8mmHgtidal volume 6-8 ml/kgable to protect airway (cough, gag and swallow reflexes intact)positive cuff leak testminimal secretionsa strong, effective coughBlood Gas ParameterspH 7.35 7.45.[3]PaCO2 <45mmHgPa02 > 70mgHg on 0.4 FIO2 HCO3 20 30mmol/LBE 5 to +5 mmol/LO2 sat> 95%CardiovascularThe patient must have: absent or only low dose inotrope/vasopressors (see Alert box)a stable blood pressure in a sitting positiona stable cardiac rhythm adequate perfusion.MetabolicThe patient's temperature must be greater than 36° but less than 39°C.SurgicalThe patient must have:less than 100ml per hour draining from intercostal drain, and/orno evidence of tamponade.Back to Table of Contents Implementation This guideline will be implemented and communicated to the Intensive Care staff and incorporated into existing training programs, orientation plans and staff communication folder.Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationPoliciesExtubation Standard Operating Procedure Back to Table of ContentsReferencesElliot D, Aitken L, Chaboyer W. ACCN’s Critical Care Nursing. Australia: Elsevier; 2010.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.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.Thille A,Cortes-Puch I, Esteban A. Weaning from the ventilator and extubation in ICU review.[internet].2013[Cited2013 Feb];19(1)57-64.Back to Table of ContentsSearch Terms Cardiac ExtubationExtubationBack to Table of ContentsDisclaimer: 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 AmendedSection AmendedApproved ByEg: 23 February 2016Section 1ED/CHHSPC Chair ................
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