Because endotracheal (breathing tubes) were sometimes, in the past, left in place too long or were removed incorrectly, a protocol for extubation was developed by Drs. Mary Schroth and John Bach. This protocol is quite technical and meant for you to share with your doctor.

Duchenne Extubation Protocol

BEFORE EXTUBATION

For INTUBATED patients, q 4 hours airway clearance AND prn Cough Assist:

  1. Cough Assist: 5 sets of 5 breaths;
    Inspiratory pressure: +35 or +40 for 2 seconds;
    Expiratory pressure: -35 or -40 for 2 seconds;
    Pause: 2 seconds
  2. ETT suctioning followed by BAGGING.
  3. Vest Therapy or Chest PT for 20 to 30 minutes.
  4. Cough Assist: 5 sets of 5 breaths as above; end on inspiration to re-expand.
  5. ETT suctioning followed by BAGGING.

* Cough Assist can be used every 10 minutes followed by ETT suctioning and BAGGING *

AFTER EXTUBATION

  • EXTUBATE to home or full nasal ventilation and NO supplemental O2.
    (eg. BIPAP of (14-20)/(3-6) using spontaneous timed mode; backup rate = spontaneous rate)
  • After EXTUBATION, minimum of q 4 hours airway clearance AND prn Cough Assist as above.
    • Expect frequent Cough Assist for first 1-2 hours after EXTUBATION.
  • Wean from nasal BIPAP or ventilation during the day as tolerated; GOAL: only with sleep.

Adapted from Univ of Wisconsin (Mary Schroth MD) 12/20/04 handout; Bach JR et al, Spinal muscular atrophy type 1: a noninvasive respiratory management approach. CHEST 2000; 117:1100. Bach JR et al, Extubation of patients with neuromuscular weakness: a new management paradigm. CHEST 2010; 173(5): 1033.
(ver.1/5/2017; LFW/SP/DS)