Implementation of an Extubation Huddle Protocol Reduces Time to Successful Extubation

Tuesday, March 24, 2026

12:30 PM - 1:30 PM Central Time

Location: Connections Central - RST 13

BF

Brittany Fitts, BSN, RN (she/her/hers)

Nemours, Pennsylvania

Disclosure(s): No relevant financial relationship(s) to disclose.
CD

Cheryl Dominick, MA

Respiratory Therapy Manager - Critical Care
Nemours Children's Hospital, Delaware

Disclosure information not submitted.
NB

Nadia Boussalham, BS RRT

Lead Respiratory Therapist - PICU
Nemours Children's Hospital, Delaware

Disclosure information not submitted.
AZ

Anne Marie Zawistowski-Cuna, BSN, RN

Clinical Operations Leader
Nemours Children's Hospital, Delaware

Disclosure information not submitted.
KM

Kimberly McMahon, MD

Pediatric Intensivist
Nemours Children's Hospital, Delaware

Disclosure information not submitted.

Introduction: Ventilator liberation bundles reduce time on the ventilator while balancing the risk of extubation failure. In 2019, we developed a spontaneous breathing trial (SBT) protocol, however time to extubation remained prolonged after passing an SBT. In January 2023, we developed an extubation huddle protocol to reduce time to successful extubation.

Methods: Using quality improvement (QI) methodology, we prioritized reducing intubation duration. For 2025, we aim to reduce mean time from passed SBT to extubation from 22.5 to 12 hours without increasing 24-hour extubation failure. A standardized extubation huddle was developed to improve awareness and planning. When a patient is successful for 30 minutes of an SBT, a multidisciplinary huddle is held to discuss plans for extubation. Through multiple plan-do-study-act cycles, the process has been refined with weekly reviews to monitor compliance and outcomes.

Results: In 2023, there were 109 extubations (91 patients) following a per-protocol SBT, with 47 (43%) preceded by an extubation huddle. 11 huddles (23%) occurred during the first passed SBT. In 2024, there were 79 per-protocol extubations (75 patients), with 71 (90%) preceded by an extubation huddle. 25 huddles (35%) occurred during the first passed SBT. From January to June 2025, 48 per-protocol extubations (44 patients) occurred, with 44 (92%) involving an extubation huddle. 26 (59%) were conducted during the first SBT. Mean mechanical ventilation time went up in 2024, but down in 2025 (3.62, 4.72, 3.12 days). A reduction in PICU length of stay (LOS) (15.1 ,13, 7.7 days) and a reduction in time from passing an SBT to extubation (18.5, 22.5, 12 hours) have occurred over time. Extubation failure rates declined over time from 8.3% in 2023, 5.1% in 2024 to 2.1% in the first half of 2025.

Conclusions: Structured extubation huddles improved clinical outcomes, reducing ventilator duration, PICU LOS and time to extubation after successful SBTs without increasing extubation failure rates. Clinical outcomes improved the most when huddles occurred more often during the first passed SBT. This suggests that structured team communication and timely decision making during the first successful SBT contributes to more efficient extubations. Ongoing QI efforts should promote ongoing and early huddle use.