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Search Results: 1 - 10 of 5580 matches for " extubation failure "
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The cuff-leak test: what are we measuring?
Daniel De Backer
Critical Care , 2004, DOI: 10.1186/cc3031
Abstract: Tracheal extubation of patients is still a major challenge, with the possibility of post-extubation stridor and then re-intubation if the patient is unable to sustain the increase in respiratory work. Stridor is responsible for 15–38% of extubation failures [1-3] and for close to 38% of early extubation failures [3]. Recognition of stridor is important because these patients can benefit from close monitoring and from specific therapies including non-invasive respiratory assistance, aerosolized adrenaline (epinephrine), and steroids (even though the efficacy of steroids remains under debate). Ideally, patients at risk of developing laryngeal edema should be identified as early as possible, and the cuff-leak test has been proposed for this purpose. The principle of this test is quite simple and is based on the fact that the air leak around a tracheal tube with a cuff deflated will be inversely related to the degree of laryngeal obstruction generated by laryngeal edema.The cuff-leak test was developed initially in children with croup [4]; extubation was likely to be successful if an air leak could be heard when the baby coughed during positive pressure ventilation. The test was further refined to allow quantitative measurements, using the difference between the expired tidal volume with the cuff inflated and with the cuff deflated: the higher the leak, the lower the likelihood that post-extubation stridor will occur. The discrimination power of the test is highly variable (Table 1), depending on the population investigated, the incidence of post-extubation stridor (ranging from to 4% to 38%), the method of determination of cuff leak (absolute value versus value relative to tidal volume measured with an inflated cuff, number of measurements of tidal volumes averaged, and so on). But perhaps more importantly, the cut-off value should be adapted to the situation; the cut-off that is usually given in most studies assumes an equivalent impact of false positive and false neg
Extubation failure in intensive care unit: Predictors and management
Kulkarni Atul,Agarwal Vandana
Indian Journal of Critical Care Medicine , 2008,
Abstract: Extubation failure-need for reintubation within 72 h of extubation, is common in intensive care unit (ICU). It can cause increased morbidity, higher costs, higher ICU and hospital length of stay (LOS) and mortality. Patients with advanced age, high severity of illness at ICU admission and extubation, preexisting chronic respiratory and cardiovascular disorders are at increased risk of extubation failure. Unresolved illness, development and progression of organ failure during the time from extubation to reintubation and reintubation itself have been proposed as reasons for increased morbidity and mortality. Parameters used to predict extubation failure can be categorized into parameters assessing respiratory mechanics, airway patency and protection and cardiovascular reserve. Adequate cough strength, minimal secretions and alertness are necessary for successful extubation. Evidence suggests that early institution of non-invasive ventilation and prophylactic administration of methylprednisolone may prevent reintubation in some patients. The intensivist needs to identify patients at high risk of extubation failure and be prepared to reinstitute ventilation early to prevent adverse outcomes.
Incidência e principais fatores associados à falha de extuba??o em recém-nascidos com peso de nascimento < 1.250 gramas
Hermeto, Fernanda;Martins, Bianca M. R.;Ramos, José R. M.;Bhering, Carlos A.;Sant'Anna, Guilherme M.;
Jornal de Pediatria , 2009, DOI: 10.1590/S0021-75572009000500005
Abstract: objectives: to determine the incidence of extubation failure in preterm newborns with birth weight < 1,250 g extubated to nasal continuous positive airway pressure and to identify the main risk factors associated with the need for reintubation in this population. methods: a retrospective review of eligible infants admitted and mechanically ventilated between july 2002 and june 2004 was performed. extubation failure was defined as the need for reintubation within 7 days after the first extubation attempt. results: of the 52 patients included in the study, 13 died before the first extubation attempt. of the remaining 39 patients, only nine failed extubation (23.1%) comparing the two groups (failure vs. successful), there was a statistically significant difference regarding birth weight, gestational age and 5-minute apgar score. after logistic regression, only gestational age was significant. other secondary outcomes showed significant difference between the groups: intracranial hemorrhage grade iii and/or iv, patent ductus arteriosus and death. conclusions: the incidence of extubation failure in our population was similar to the rate reported in the literature. the main risk factor for extubation failure was prematurity (≤ 28 weeks). in this population of extreme preterm infants, implementation of strategies for early extubation, use of methylxanthines, prevention of patent ductus arteriosus, and use of different modes of assisted ventilation after extubation may improve the outcomes.
Factors Related to Extubation Failure and Post Pulmonary Complications in Intracranial Surgery in 254 Patients: a Brief Report
SV Heydari,SM Ramak Hashemi,EA Abasnejad,F Abbasi Gravnd
Tehran University Medical Journal , 2012,
Abstract: Background: The purpose of this study was to determine the prevalence and associated factors for postoperative pulmonary complications (PPCs) and extubation failure in patients having undergone intracranial surgery.Methods: In this retrospective study done in Firozgar Hospital during 2008-2010, we followed up 254 patients through a clinical questionnaire and observation of the clinical course of participants in pre- and post-operative periods.Results: Overall, 40 (15.74%) patients had postoperative pulmonary complications. The most common PPC was pneumonia, which was seen in 24 patients (60% of complications). The average duration of ventilation in patients with PPC was significantly higher (16.8.±10 vs. 5.09±4.5 days; P=0.001) than patients without the complication. The mean Glasgow coma scale (GCS) after surgery in patients with PPC was significantly lower (11.±4 vs. 13.2±3; P=0.001) than the rest of the patients. Moreover, the mean age of patients with PPC was significantly higher (64.02±14 vs. 41.6.±17 years; P=0.001). Average duration of stay in ICU in patients with PPC was also higher (24.±27 vs. 8.7±0.5; P=0.001).Conclusion: GCS before surgery and failed extubation independently of other variables were significantly associated with pulmonary complications independent of other variables.
Variation of vascular ring as a cause of extubation failure
IVANCICA SKARIC,JASMINKA JAKOBOVIC,MAJA KARAMAN ILIC,KARMEN KONDZA
Signa Vitae , 2008,
Abstract: We report on an unexpected extubation failure in a two year old boy. In our patient, failure of extubation led to a diagnostic examination. The result of our examination was discovery of a congenital anomaly of the aortic arch and great vessels (vascular ring) with compression of the trachea. The presence of this anomaly in this patient was unknown to us before. A successful surgical procedure eliminated the underlying cause of the persistent extubation failures.
Extubation failure: an outcome to be avoided
Scott K Epstein
Critical Care , 2004, DOI: 10.1186/cc2927
Abstract: The art and science of discontinuing patients from invasive mechanical ventilation continues to attract attention. The discontinuation process consists of two components: weaning (assessing the need for ventilatory support) and extubation (assessing the need for an airway). Investigators have increasingly focused on the latter component, where 5–20% of extubations may fail and require reintubation.Both unnecessarily delayed extubation and 'premature' extubation are associated with adverse outcomes. Delayed extubation is associated with increased length of stay, increased risk for ventilator-associated pneumonia, and increased mortality in brain-injured patients [1]. Conversely, reintubation (extubation failure) after planned extubation is associated with adverse outcomes, including increased hospital mortality, prolonged hospital stay, higher costs, and greater need for tracheotomy and transfer to postacute care [2-4]. Although the adverse effects of reintubation could reflect the severity of underlying illness or could result from complications during reintubation, this has not been demonstrated with multivariate analysis [2-4]. Rather, delayed timely reinstitution of ventilatory support may allow for deterioration and new organ failure, ultimately contributing to increased mortality and increased costs [5].In response to this observation, investigators have examined whether postextubation application of noninvasive ventilation (NIV) can improve outcome. Unfortunately, NIV did not improve outcome for established postextubation respiratory failure [6] and was actually associated with increased intensive care unit (ICU) mortality when used in a large cohort with early signs of extubation failure (only 10% of whom had chronic obstructive pulmonary disease) [7].Studies of extubation failure have been almost exclusively performed in academic medical centers. Hence the relevance of the study by Seymour and colleagues, who extend previous work by finding that extubation f
The outcome of extubation failure in a community hospital intensive care unit: a cohort study
Christopher W Seymour, Anthony Martinez, Jason D Christie, Barry D Fuchs
Critical Care , 2004, DOI: 10.1186/cc2913
Abstract: A retrospective cohort study was performed using data gathered in a 16-bed medical/surgical ICU in a community hospital. During 30 months, all patients with acute respiratory failure admitted to the ICU were included in the source population if they were mechanically ventilated by endotracheal tube for more than 12 hours. Extubation failure was defined as reinstitution of mechanical ventilation within 72 hours (n = 60), and the control cohort included patients who were successfully extubated at 72 hours (n = 93).The primary outcome was total ICU length of stay after the initial extubation. Secondary outcomes were total hospital length of stay after the initial extubation, ICU mortality, hospital mortality, and total hospital cost. Patient groups were similar in terms of age, sex, and severity of illness, as assessed using admission Acute Physiology and Chronic Health Evaluation II score (P > 0.05). Both ICU (1.0 versus 10 days; P < 0.01) and hospital length of stay (6.0 versus 17 days; P < 0.01) after initial extubation were significantly longer in reintubated patients. ICU mortality was significantly higher in patients who failed extubation (odds ratio = 12.2, 95% confidence interval [CI] = 1.5–101; P < 0.05), but there was no significant difference in hospital mortality (odds ratio = 2.1, 95% CI = 0.8–5.4; P < 0.15). Total hospital costs (estimated from direct and indirect charges) were significantly increased by a mean of US$33,926 (95% CI = US$22,573–45,280; P < 0.01).Extubation failure in a community hospital is univariately associated with prolonged inpatient care and significantly increased cost. Corroborating data from tertiary care centers, these adverse outcomes highlight the importance of accurate predictors of extubation outcome.Approximately 10–15% of patients who are extubated from mechanical ventilation for acute respiratory failure require reintubation. Compared with patients who are successfully extubated, patients who are reintubated have worse cli
Ventila??o mecanica n?o-invasiva aplicada em pacientes com insuficiência respiratória aguda após extuba??o traqueal
José, Anderson;Oliveira, Luiz Rogério de Carvalho;Dias, Elaine Cristina Polleti;Fuin, Daniela Brand?o;Leite, Leslie Gomes;Guerra, Graziele de Souza;Barbosa, Deise do Carmo;Chiavone, Paulo Antonio;
Revista Brasileira de Terapia Intensiva , 2006, DOI: 10.1590/S0103-507X2006000400004
Abstract: background and objectives: noninvasive positive pressure ventilation (nppv) has been routinely used to assist the weaning of the mechanical ventilation. one of the applications most common is in patients who had acute respiratory failure after extubation, even the scientific evidences for this indication still controversy. the aims of this study were to evaluate the index of patients that evolve for respiratory failure after extubation and evaluated the effectiveness of nppv to avoid the need for reintubation and to promote increase in success index of weaning. methods: we conducted a transversal and prospective study. it was applied to nppv in the patients who presented respiratory failure after extubation, independent of its etiology. nppv was applied in to pressure support ventilation, with vte for 6 to 8 ml/kg, peep and fio2 adjusted to reach sao2 > 95%. the nppv was accomplished of a continuous mould even interrupt the signs of respiratory failure presented initially. the success of weaning and the nppv was defined when the clinical events were reverted by a period greater than 48 hours in spontaneous breathing, avoid thus reintubation. results: we included 103 patients. noted that 32% (33) evolved with signals of respiratory failure after extubation and were submitted to nppv. the time of nppv was on mean 8 ± 5 hours, psv of 12 ± 2 cmh2o, peep of 7 ± 2 cmh2o, fio2 of 40% ± 20%, vte of 462 ± 100 ml, rr of 26 ± 5 rpm. among patients who accomplished nppv (33), 76% (25) attended with success and them afterwards let the icu. of the patients assigned to nppv, 24% (8) did not tolerate the procedure and were reintubated. conclusions: we conclude that nppv is safe and effective in averting the need for reintubation in patients with respiratory failure after extubation.
Extubación fallida en pacientes pediátricos después de cirugía de cardiopatías congénitas
Valle M.,Patricio; Ronco M.,Ricardo; Clavería R.,Cristián; Carrasco O.,Juan A.; Castillo M.,Andrés; Córdova L.,Guiliana; Rodríguez C.,José I.;
Revista chilena de pediatría , 2005, DOI: 10.4067/S0370-41062005000500004
Abstract: introduction: extubation failure (ef) is a common complication after congenital heart disease surgery (chds), ranging from 6.7% to 22%. there are few publications that identify risk factors associated with ef in these patients. objective: to determine the rate of ef after chds and identify risk factors. method: a 3 years retrospective chart review of children less than 3 years-old who underwent chds with cardiopulmonary bypass (cpb). preoperative, operative and postoperative data was collected, including cardiac defect and type of surgery repair. results: 242 children after chds were studied, with ef rate of 9.9%. significant risk factor for ef during surgery was deep hypothermic circulatory arrest (dhca) (p = 0,0043 or = 3,1) and postoperative was laryngeal stridor (p = 0,0006 or = 21,6). down syndrome and age less than 6 months were identified as independent risk factors. finally, ef was associated with longer mechanical ventilation and higher incidence of pulmonary infections. conclusions: around 10% of extubation trials failed in patients with chds and cpb, a rate that is similar to the ones reported in other clinical reviews. in our study, the main risk factors for ef were laryngeal stridor after extubation, dhca, down syndrome and age less than 6 months. the ef was associated with longer mechanical ventilation and lung infection
Infant flow biphasic nasal continuous positive airway pressure (BP- NCPAP) vs. infant flow NCPAP for the facilitation of extubation in infants' ≤ 1,250 grams: a randomized controlled trial
Karel O'Brien, Craig Campbell, Leanne Brown, Lisa Wenger, Vibhuti Shah
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-43
Abstract: We performed a randomized controlled trial of BP-NCPAP vs. NCPAP in infants ≤ 1,250 grams extubated for the first time following mechanical ventilation since birth. Infants were extubated using preset criteria or at the discretion of the attending neonatologist. The primary outcome was the incidence of sustained extubation for 7 days. Secondary outcomes included incidence of adverse events and short-term neonatal outcomes.Sixty-seven infants received BP-NCPAP and 69 NCPAP. Baseline characteristics were similar between groups. The trial was stopped early due to increased use of non-invasive ventilation from birth, falling short of our calculated sample size of 141 infants per group. The incidence of sustained extubation was not statistically different between the BP-NCPAP vs. NCPAP group (67% vs. 58%, P = 0.27). The incidence of adverse events and short-term neonatal outcomes were similar between the two groups (P > 0.05) except for retinopathy of prematurity which was noted to be higher (P = 0.02) in the BP-NCPAP group.Biphasic NCPAP may be used to assist in weaning from mechanical ventilation. The effectiveness and safety of BP-NCPAP compared to NCPAP needs to be confirmed in a large multi-center trial as our study conclusions are limited by inadequate sample size.NCT00308789Grant # 06-06, Physicians Services Incorporated Foundation, Toronto, Canada. Summit technologies Inc. provided additional NCPAP systems and an unrestricted educational grant.Abstract presented at The Society for Pediatric Research Meeting, Baltimore, USA, May 2nd-5th, 2009 and Canadian Paediatric Society Meeting, June 23rd-29th, Ottawa, 2009.With advances in neonatal care, > 85% of infants with birth weight < 1,500 grams now survive [1,2]. Parallel to this improved survival is the increase in the incidence of bronchopulmonary dysplasia (BPD). In 2001, the National Institute of Child Health and Human Development Neonatal Research Network reported an incidence of BPD of up to 40% in infants < 1,0
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