The Oximetry Feedback Respiratory Aid Protocol

Intubation is often avoidable by using NIPPV and assisted coughing. It is the ability to successfully extubate ventilator-dependent patients to NIPPV that enables tracheostomy to be avoided in most patients with NMD (15,17). 

Patients with NMD can be extubated to NIPPV despite little or no autonomous ventilatory capacity. Postextubation CPF is a good predictor of successful extubation as it reflects bulbar-innervated muscle integrity, and therefore, the ability to eliminate airway secretions (10,11). Preextubation peak expiratory flows have also been shown to predict success in extubating patients with primarily respiratory impairment (28). 

Oxygen administration limited to achieve Spo2 no higher than 95%. 

Mechanically assisted coughing used via the invasive tube up to every few minutes as needed to fully expand and quickly empty the lungs to reverse oxyhemoglobin desaturation due to airway mucus accumulation when baseline Spc 2 decreases, when there is auscultatory evidence of secretion accumulation, and on patient demand. Tube and upper airway are suctioned following use of expiratory aids. 

Ventilator weaning attempted without permitting hypercapnia. 

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