Education - How to Use the Pathway

The Extubation pathway will soon be introduced at our two ICUs at LHSC (these being MSICU [medical surgical intensive care unit] at University Hospital and CCTC [critical care trauma centre] at Victoria Hospital). Given the rapid turn-around of patients and their at the CSRU (Cardiac Surgery Recovery Unit) and the nature of the cardiac surgery post-operative patient, the extubation pathway will not be introduced there. At present, the extubation pathway has been approved by the Clinical Practice Committee (CPC) at CCTC and has been reviewed by members of the CPC at MSICU. We are embarking on a research study as well to assess the impact of the extubation pathway on re-intubations by comparing epochs of time both pre- and post-introduction of the pathway. The study will be year-long and we also would like to survey Respiratory Therapist extubation practices pre- and post- introduction of the pathway to see its impact on daily practice. 

The pathway will be introduced in the form of a laminated checklist to be present in the RT binder of each patient at their bedside. It is to be used at the time of extubation, once an order to extubate has been entered electronically on our electronic patient record. No documentation in the chart will be necessary. The aim of the checklist is to insert a "cognitive pause" before extubation takes place by recognizing the following steps:

Is there an order to extubate the patient?
  • A) Is the patient ready for extubation
  • B) Is the patient at risk of post-extubation failure (failure of extubation defined as re-intubation within 48 hours)
  • C) Are there risk factors for difficult re-intubation
This "ABC" approach of the checklist culminates in Step D, where the decision to extubate the patient is re-assessed and appropriate measures are taken. In the final step of the pathway, several evidence-based guidelines are rendered as standard of care.

Please watch the below video as an educational piece as the pathway is introduced. Please direct your questions to

We hope you enjoy this educational video.

Extubation Pathway Educational VodCast