In this section
Definition of Terms
Complications/Causes of Failed Extubation
Mechanical ventilation is commonly delivered through an endotracheal tube (ETT) within the Neonatal Intensive Care Unit (NICU). Extubation involves removal of the ETT from the trachea. Early and successful extubation can reduce complications such as ventilation acquired pneumonia (VAP).
This guideline will provide information about the nursing assessment, management and complications of neonatal extubation.
Nursing staff can optimise patient safety and comfort during, and post-extubation. This can include:
Medical staff will assess the readiness of the neonate for extubation. This will include deeming the patient as low-risk for re-intubation. Common signs the patient is ready for extubation:
Note: Careful consideration must be made for patients who have had previous failed attempts at extubation, and the reasons for the failure. Peri-extubation drugs may be used to optimise extubation (see
Steroid use in NICU)
Continuously assess clinical stability of the patient post-extubation. This includes, but not limited to:
Document vital signs pre, during and post-extubation
Management of upper
airway obstruction post-extubation may require nebulised adrenaline and/or
steroids (See Steroid use in NICU). Medical staff are required to order this via
EMR prior to administration.
Adrenaline 1:1000 (1mg/ml) ampoules are the first
line management within the NICU. The dose for neonates is 0.5ml/kg, further diluted normal saline (NaCl) to a total of 6mls,
and delivered via nebuliser with 8-10L/min flow.
Consider a maximum dose of 5mg for patients 1 month or older
Education for family members regarding extubation is an important aspect of the neonate’s holistic care plan. Education may include:
Family-centered care is one of our key priorities during medical and nursing procedures. Communication surrounding the extubation procedure is vital, and should be completed as early as possible. Communication can be updated in EMR ‘Progress Notes’.
Please remember to
read the disclaimer
The revision of this nursing guideline was authored by Shanai Cramer, Clinical Nurse Specialist, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated September 2020.