Extubation failure in intensive care unit: Predictors and management

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.

The influence of music during mechanical ventilation and weaning from mechanical ventilation: A review

“…3,8 Delays in extubation can be due to severe respiratory muscle deconditioning, poor nutrition, upper airway edema, and decreased level of consciousness secondary to over-use of sedative medications. 9 Extubation failure can lead to ventilator-associated pneumonia, airway trauma, increased costs and high mortality rates. 10 Patients who require MV for greater than 3 weeks account for more than 50% of total ICU costs.…”

“…4 As the acute cause of respiratory failure resolves and the patient can tolerate independent respirations, the artificial airway is removed. 9,10,18 For some, weaning can be a lengthy process. Recent estimates state that more than 40% of the total duration of MV is spent enduring the weaning process.…”

“…9 Extubation failure can lead to airway trauma, ventilator-associated pneumonia, gastrointestinal bleeding, and blood clots. It can increase costs, result in longer ICU stays, and increase morbidity and mortality.…”

“…It can increase costs, result in longer ICU stays, and increase morbidity and mortality. 6,9,10 It has been estimated that extubation failure occurs at least once in up to 47% of mechanically ventilated patients. 9 Timely, effective weaning is critical to decreasing the personal and economic cost of MV and extubation failure.…”

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

“…SOT devices are used to treat this complication, but they may be inadequate in patients with high inspiratory flow, since they can provide oxygen at flow rates <15 L·min −1 [21,32,33]. RITTAYAMAI et al [34], in a crossover study, compared 30-min interventions with NHF and a non-rebreathing mask in recently extubated patients.…”