Liberation from invasive ventilation is one of the most important goals of critical care medicine. Numerous RCTs have improved our understanding of this process, but it remains as much an art as a science. When in doubt, empirical trials of spontaneous breathing and extubation are more accurate than our predictive ability.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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In regards to extubating obese, especially morbidly obese patients, I’ve found a lot of success with aggressive reverse Trendelenburg positioning. I feel like getting these patients as close to a standing position as possible helps with diaphragmatic excursion and also helping offload their lungs. Not sure if you’ve used this in your practice?
at my facility we do sedation vacations and spontaneous breathing trials in the morning around five to six a.m. patients who pass and do well on pressure support then proceed to be extubated around eight to nine a.m. All resources that I’ve read say liberation can be done after thirty minutes to two hours if all goes well. Currently I am working on redoing our ventilator policies and guidelines for nursing staff and I was wondering if other facilities deal with this timing issue and how to decrease the amount of time patients are waiting on clinicians or if this… Read more »