A patient has been breathing 5 cm H2O of pressure support ventilation for 1½ hours. What patient characteristics should the therapist consider to determine readiness for extubation? I. Does the patient have an FEV1 greater than 75% of predicted? II. Does the patient have the ability to generate an adequate cough? III. Does the patient have thick secretions? IV. Is the patient capable of

following commands?

A. I, III only
B. II, IV only
C. I, III, IV only
D. II, III, IV only

ANS: B
A. Incorrect response: See explanation B.
B. Correct response: Once the patient has demonstrated the ability to breathe spontaneously for 90 to 120 minutes, consideration must be given to remove the ETT. That decision should be based on the following criteria. (1) Does the patient have the ability to protect the airway? The patient must demonstrate a strong cough and exhibit a minimal need for suctioning. (2) Is the patient alert and capable of following commands? This criterion is the rationale for reassessing and minimizing sedation on a regular basis. (3) Would reintubation of this patient be difficult? In borderline cases, the decision to remove the artificial airway may need to take into account the difficulty anticipated in replacing the airway if needed.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B