Extubation After Being on a Ventilator

Extubation is the process of having the endotracheal tube removed. During this process, the nurse removes the air from the inflated gasket on the tube and releases the ties or tape that holds the tube in place. The tube is then gently pulled from the patient's mouth or nose. At this point, they are able to breathe on their own and the ventilator is no longer able to provide any breathing assistance. Most patients are given oxygen to help with this process, either through a mask or nasally.

Most patients cough during the process, but it is not typically painful. Many patients do complain of a sore throat after being intubated, so throat sprays, lozenges or numbing medications may be used if the patient can tolerate them and they can be used safely.

Care While on a Ventilator

Patient care for the individual on a ventilator often consists of preventing infection and skin irritation. These patients are almost always in an intensive care unit (ICU) and receive constant monitoring and attention.

Tape or a strap is used to keep the endotracheal tube in place, this is changed when dirty and the tube is regularly moved from one side of the mouth to the other. Moving the tube is done to prevent skin irritation and breakdown from the tube rubbing against the tissues of the mouth.

Mouth care is frequently performed to prevent infection. The mouth is often dry, so the mouth is cleaned and moistened to protect the teeth and reduce any harmful bacteria that could make their way into the lungs and cause pneumonia. 

Oral secretions are suctioned from the mouth to prevent them from draining into the lungs and causing pneumonia. Secretions from the lungs are suctioned as the patient will be unable to cough these secretions up while on the ventilator.

Patients who require a ventilator are often too sick or weak to reposition themselves, so frequent turning is also part of routine care.

Breathing treatments are routinely provided by respiratory therapy or nursing staff, to help keep the airways open, thin secretions that may be present and treat any lung conditions that the patient may have.

Long-Term Ventilator Care

For patients who are unable to be weaned from the ventilator, a tracheostomy may be necessary. An endotracheal tube should not be left in place for more than a few weeks as it can eventually cause permanent damage to the vocal cords or windpipe and can make ventilator weaning more difficult.

For patients who are expected to be on a ventilator long term, a surgically created opening is made in the neck and the ventilator is attached there, rather than functioning through the tube placed in the mouth.

Patients are often transferred to a Long Term Acute Care (LTAC) facility that provides ventilator care. These facilities often have units where ventilator weaning is their specialty, and the process of helping the patient relearn how to breathe effectively is part of daily care.