In this section
Definition of Terms
Post Extubation Assessment
Complications/Causes of Failed Extubation
Neonates in intensive care often require intubation and mechanical ventilation for a period of time. Neonates should be extubated as soon as possible in order to avoid potentially harmful complications. Extubation should only be carried out by a qualified competent health care professional.
This guideline aims to provide health carers with information to extubate a neonate in NICU in a safe and timely manner.
Indications that a neonate is ready for extubation:
Note: Consideration must be given to previous unsuccessful extubation attempts and the reason for their failure when planning each subsequent extubation event.
Management of upper airway obstruction post-extubation (which usually manifests as stridor and increased work of breathing) may require adrenaline nebulisers or steroids.
Nebulised adrenaline: 0.05mL/kg of 1% adrenaline* diluted to 6 mL via nebuliser with 10 L/min flow
(or 0.5 mL/kg 1:1000 adrenaline diluted to 6ml) – see table below as a guide
(*If 1% adrenaline solution is not available use 1:1000 vials)
Guide for nebulised adrenaline dosing:
mL of preparation required
0.05 mL/kg diluted to 6 mL
0.5 mL/kg diluted to 6 mL
Please remember to
read the disclaimer
The development of this nursing guideline was coordinated by Sharlene Pattie, Clinical Nurse Educator, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated February 2017.