Quick tip for families in ICU: How often can someone be extubated and intubated?

https://intensivecarehotline.com/blog/quick-tip-for-families-in-icu-how-often-can-someone-be-extubated-and-intubated/

Quick tip for families in ICU: How often can someone be extubated and intubated?

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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, today’s quick tip is about, “How often can you extubate and re-intubate someone?” So, we’ve got a client at the moment that we’re working with, and the client said that their mother is in intensive care after pneumonia, and she’s been extubated and re-intubated three times over the last week or so.

And I haven’t really seen that even though I’ve worked in intensive care for over 20 years in three different countries, where I also worked as a nurse unit manager for over five years. So, haven’t really seen that someone gets extubated and re-intubated more than once really, because once you’ve got one failed extubation, it really becomes unsafe and the tracheostomy is probably the right next step because when you extubate and re-intubate someone, you got to use anesthetics, you got to use sedation, you got to use opiates, sometimes have to use paralyzing agents. So, it’s quite taxing on the patient. So, I have not seen it more than once, maybe twice on the other occasion, but certainly not three times within a few days. That sounds rather unsafe and dangerous to me.

So, the best next step in a situation like that is really after one failed extubation, and if patient can’t be weaned off the ventilator, is not waking up appropriately, can’t manage on the BIPAP (Bilevel Positive Airway Pressure) as well because the next step is when you extubate, and you are at risk of reintubation. What really should happen is BIPAP or CPAP (Continuous Positive Airway Pressure) with a mask, non-invasive ventilation. And if that can’t be tolerated, then the next step really is a tracheostomy. It obviously depends also on arterial blood gases. It depends on the conscious state of a patient. It depends on whether they can have a good cough, depends whether they can clear the airway, depends on chest X-rays as well.

So, that is my quick tip for today.

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Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.