| Knowledge |
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States Contraindications and Relative Contraindications of procedure.
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| Preparation |
| Clinical Standards for Procedures and Interventions. |
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| Assessment |
| Confirms that the cause of respiratory failure has improved and that the patient has completed a standardized readiness assessment and spontaneous breathing trial when applicable. |
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| Assesses oxygenation and ventilation, hemodynamic stability, level of consciousness, airway-protection ability, cough strength, secretion burden, neuromuscular function, and anticipated post-extubation support. |
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| Preparation |
| Identifies difficult reintubation and extubation-failure risk, briefs the team, selects the location and timing, and prepares oxygen, suction, bag-mask ventilation, airway adjuncts, reintubation equipment, and an escalation plan. |
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| Assessment |
| Uses a cuff-leak test only for patients at elevated risk of post-extubation upper-airway obstruction and interprets a positive result as meaningful while recognizing that a negative result does not eliminate risk. |
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| Preparation |
| Selects and function-checks the planned conventional oxygen, high-flow oxygen, noninvasive ventilation, or other post-extubation support and ensures immediate access to rescue equipment. |
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| Implementation |
| Positions the patient upright as tolerated, explains the procedure, preoxygenates when indicated, and suctions the endotracheal tube and oropharynx using an appropriate technique. |
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| Removes fixation, fully deflates the cuff, and withdraws the tube smoothly using the local evidence-based extubation technique while maintaining oxygen delivery and readiness to support ventilation. |
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| Immediately applies the planned oxygen or ventilatory support and encourages effective breathing and secretion clearance as appropriate. |
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| Monitoring & Modifications |
| Closely monitors respiratory rate and effort, oxygen saturation, air entry, voice, cough, stridor, secretions, mental status, hemodynamics, and end-tidal carbon dioxide when indicated. |
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| Initiates the prescribed response for stridor or worsening gas exchange and proceeds to timely reintubation when noninvasive measures are failing rather than allowing prolonged deterioration. |
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| Post-Intervention |
| Documents readiness findings, spontaneous breathing trial result, airway-risk assessment, cuff-leak result when used, procedure, oxygen or ventilatory support, patient response, and complications. |
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| Post-Intervention Management Steps. |
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