Evaluation of two different extubation criteria

DeHaven, C. Bryan; Hurst, James Willard; Branson, Richard D.

doi:10.1097/00003246-198602000-00003

Cited by 54 publications

(16 citation statements)

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“…Coplin et al [20] found that NCCU patients with a Glasgow Coma Scale (GCS) <4, without high airway care requirements or pneumonia, and with a cough or gag reflex, may be safely extubated. In the medical-surgical ICU, such parameters are the basis of standard daily spontaneous breathing trials that facilitate rapid liberation from the ventilator [21][22][23]. At present, well-designed prospective studies in the general medical and surgical ICU support the idea that early extubation and spontaneous breathing trials reduce the rates of ventilator-associated pneumonia (VAP), reduce hospital LOS, and improve mortality [23].…”

Section: Introductionmentioning

confidence: 99%

“…In the medical-surgical ICU, such parameters are the basis of standard daily spontaneous breathing trials that facilitate rapid liberation from the ventilator [21][22][23]. At present, well-designed prospective studies in the general medical and surgical ICU support the idea that early extubation and spontaneous breathing trials reduce the rates of ventilator-associated pneumonia (VAP), reduce hospital LOS, and improve mortality [23]. Coplin and colleagues [20,24] have also completed a study that suggests that standard daily spontaneous breathing trials, when adapted for NCCU patients, may facilitate rapid liberation from ventilation.…”

Section: Introductionmentioning

confidence: 99%

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A Clinical Description of Extubation Failure in Patients with Primary Brain Injury

et al. 2011

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The extubation failure rate in our neurocritical care unit is low. In patients with encephalopathy and primary brain injury who were reintubated, respiratory distress caused by altered mental status was the most common cause of reintubation. These patients demonstrated signs disrupted ventilation usually with periods of prolonged hypoventilation. Increased work of breathing from lung injury due to pneumonia or aspiration was not the most common cause of reintubation in this population.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Clinical Description of Extubation Failure in Patients with Primary Brain Injury

et al. 2011

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“…In contrast, the success rate was significantly improved to 76.6% in patients in the sniffing position. Despite several suggested extubation criteria, [13][14][15] it is difficult to reliably predict which patients will develop respiratory distress following extubation. Generally, tracheal reintubation rates of 6-19% have been reported in surgical ICU patients.…”

Section: Discussionmentioning

confidence: 99%

“…Generally, tracheal reintubation rates of 6-19% have been reported in surgical ICU patients. 14,15 Considering the increased risk of failure in reintubating patients with cervical spine immobility or instability, extubation in these patients can be a major challenge, even for experienced anesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

Poor performance of the pediatric airway exchange catheter in adults with cervical spine immobilization

Kim

Lee

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Use of a pediatric airway exchange catheter (PAEC) has been advocated as a potentially useful adjunct for difficult extubations. We evaluated the laryngeal passing ability of a tracheal tube over a PAEC and compared its success rate between adult patients in the sniffing position and adult patients with simulated cervical spine immobilization created using a manual in-line axial stabilization (MIAS) technique. Methods:A total of 100 adult patients were randomized into two groups of equal size with respect to position during the simulated reintubation trial: the MIAS position (Group M) and the sniffing position (Group S). After induction of anesthesia, an 11-F PAEC was placed in the trachea under direct laryngoscopic view, and a wire-reinforced tube (with its bevel facing to the left) was gently railroaded over the PAEC and into the trachea. If insertion was impeded, a second attempt was made after rotating the tube 90° counterclockwise. If this also failed, one additional attempt was made using external laryngeal pressure before changing to conventional laryngoscopic intubation. Results:After the second attempt, the cumulative success rates in Groups M and S were 41.3% and 72.3%, respectively (P = 0.003). After three attempts, the overall success rate was significantly lower in Group M (52.2%) than in Group S (76.6%) (P = 0.018). Conclusion:Owing to the high failure rate of PAEC-guided intubation in patients with simulated cervical spine immobilization, use of a PAEC is not recommended for maintaining continuous airway access after extubation in adult patients with cervical immobility or instability. 41,3 % et 72,3 %, respectivement (P = 0,003 Méthode : Au total, 100 patients adultes ont été randomisés en deux groupes de taille égale selon leur position pendant l'essai de réintubation simulée : la position MIAS (groupe M) et la position de reniflement (groupe S). Après l'induction de l'anesthésie, une PAEC 11-F a été placé dans la trachée sous vision laryngoscopique di-

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“…It should also be noted that the supporters of IMV, very early on, used a room air CPAP trial to determine the suitability for extubation. 48 The allure of IMV lives on in 2016 under other names: adaptive support ventilation, airway pressure release ventilation, and biphasic ventilation, modes that my colleague has described as potentially advantageous. 6,[49][50][51] Each of these is just another method to exploit the advantages of spontaneous breathing outside the IMV brand.…”

Section: A Question Of Intentmentioning

confidence: 99%

Should Intermittent Mandatory Ventilation Be Abolished?

Kacmarek

Branson

2016

Respiratory Care

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Intermittent mandatory ventilation (IMV) was introduced nearly 50 years ago. Despite the initial fanfare and early adoption by many, the role of IMV continues to be questioned. The use of small tidal volumes complicates the application of IMV, and issues with work of breathing, weaning and lack of clear advantages have many calling for a moratorium on its use. Spontaneous breathing, however, has a number of salutatory effects on gas exchange, the distribution of ventilation, and hemodynamics. These issues will be explored in light of a growing body of evidence. Key words: Mechanical ventilation, intermittent mandatory ventilation, synchronized intermittent mandatory ventilation, asynchrony and work of breathing. [Respir Care 2016;61(6):854 -866.

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Evaluation of two different extubation criteria

Cited by 54 publications

References 0 publications

A Clinical Description of Extubation Failure in Patients with Primary Brain Injury

A Clinical Description of Extubation Failure in Patients with Primary Brain Injury

Poor performance of the pediatric airway exchange catheter in adults with cervical spine immobilization

Should Intermittent Mandatory Ventilation Be Abolished?

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