Collaborative extubation; best practice?

Extubation of very low birth weight (VLBW) neonates is a crucial stage in their and their families' lives. Despite this, there are very little nursing studies published regarding the care of the baby around the time of extubation. The author hypothesised that successful extubation is a collaborative effort between nursing and medical staff, the actions of the nurse being highly influential. In order to test this hypothesis the author carried out an audit over 2 months of planned extubations of VLBW neonates. Following a literature review a number of medical and nursing parameters were identified to be included in the audit. Although only 11 babies were reviewed the findings have resulted in the change in both the medical and nursing guideline. Results showed that the successful extubations were given a higher dose of caffeine. Findings around the nursing issue of handling were most notable as every baby which failed extubation had ‘all cares’ at the time of the procedure. All of the successful babies had ‘all cares’ 1–2 h pre-extubation.