A variety of skills are required to care for highly dependent and critically ill children and young people. You should think about the following when on relevant placements:

• PICU patients are intubated for a variety of reasons. Some of these are due to a primary airway problem (e.g. airway swelling/croup), secondary conditions that place the airway at risk (e.g. sedation/anaesthesia, low GCS) and/or other conditions that require mechanical ventilation (e.g. pulmonary conditions).
• When problems are resolved and the patient no longer requires an artificial airway, this device must be removed and the patient liberated from mechanical ventilation. This procedure is known as extubating the child or decannulation if it is a tracheostomy.
• The key to successful liberation is patient assessment. Practising your assessment skills for children who are being liberated from mechanical ventilation, who are being extubated or decannulated will enhance your assessment skills further.