Extubation Checklist

  • Is the process that caused respiratory failure reversed?
  • Is the ventilator providing sufficiently low support? (typically < 1/4 of total minute ventilation)
  • Is the patient safe to extubate in the PICU?
  • Are sedatives sufficiently reduced or discontinued?
  • Is the patient awake enough?
  • Is the patient strong enough?
  • Can the patient protect her/his airway (i.e. cough and gag present)?
  • Are airway secretions a problem?
  • Is bedside suctioning available?
  • Is a bag and mask at the bedside?
  • Is there an air leak around the ET tube?
  • Is there a need for precautionary dexamethasone for airway edema?
  • Is the patient adequately NPO?
  • Will extubation be to nasal cannula or to non-invasive positive pressure?
  • Is pharmacological support during extubation needed, such as afterload reduction?
  • Is it necessary to have re-intubation medications drawn-up and equipment ready?
  • Is it necessary to have alternate airways ready? (LMAs, OP airways and nasal trumpets)
  • Will nasal (NG, ND) tubes come out or stay in?
  • Have the risks and implications of extubation failure been discussed with the family?