Title: Extubating in the ED
题目：在急诊科的气管拔管
Author 作者: Michael Winters

With the increasing LOS for many of our intubated critically ill ED patients, it is possible that select patients may be ready for extubation while still in the ED.
由于很多在急诊科插管后的危重病人的滞留时间长，其中有些人在急诊科时就可以将气管拔出。
Patients who remain intubated unnecessarily are at increased risk for pneumonia, increased hospital LOS, and increased mortality.
没必要继续保留插管的病人将增加肺炎，住院时间，和死亡率。
To be considered for extubation, patients should meet the following criteria:
可以拔管的病人应该满足下列条件：
The condition that resulted in intubation is improved or resolved
导致插管的病因有改善或治愈
Hemodynamically stable (off pressors)
血液动力学稳定（不用升压药）
PaO2/FiO2 > 200 with PEEP < 5 cm H2O
血氧浓度／供氧浓度分数大于200，PEEP小于5cmH2O
If these criteria are met, perform a spontaenous breathing trial (SBT).
如这些条件都满足了，要进行自主呼吸试验（SBT）
Discontinue sedation
停止镇静药
Adjust the ventilator to minimal settings: pressure support or CPAP (5 cm H2O) or use a T-piece.
将呼吸机条件降到最低：压力支持或CPAP小于5cmH2O或用T管
Perform the trial for at least 30 minutes.
SBT试验至少要30分钟
If the patient develops a RR > 35 bpm, SpO2 < 90%, HR > 140 bpm, SBP > 180 mm Hg or < 90 mm Hg, or increased anxiety, the SBT ends and the patient should remain intubated.
如病人的呼吸超过35次／分钟，氧饱和度低于90％，心率快于140次／分钟，收缩压高于180或低于90mmHg，或焦虑加重，应停止SBT，病人要继续保持插管。
Before removing the endotracheal tube, be sure to assess mentation, the quantity of secretions, and strength of cough.
在拔管前，一定要检查神志，分泌物的量，和咳嗽的力度。

References 参考文献：
McConville JF, Kress JP. Weaning patients from the ventilator. NEJM 2012; 367:2233-9.