Outcome of reintubated patients after scheduled extubation

Frutos‐Vivar, Fernando; Esteban, Andrés; Apezteguía, Carlos; González, Marco; Arabi, Yaseen M.; Restrepo, Marcos I.; Gordo, Federico; Santos, Cristina; Alhashemi, Jamal A.; Pérez, F.; Peñuelas, Óscar; Anzueto, Antonio

doi:10.1016/j.jcrc.2010.12.015

Cited by 229 publications

(194 citation statements)

References 26 publications

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“…1 Although the majority of patients with acute respiratory failure who pass an SBT will easily wean from ventilatory support, postextubation respiratory failure may develop in ϳ10 -25% of patients. [2][3][4][5][6][7][8][9][10] Extubation failure, irrespective of the baseline severity of the underlying illness, has been shown to be associated with higher morbidity and mortality. 2,3 The mortality rate in re-intubated patients is as high as 43% compared to only 12% in those successfully extubated.…”

Section: Introductionmentioning

confidence: 99%

“…2 Patients who require re-intubation also have an increased risk of developing pneumonia and sepsis. 7,10,11 Frutos-Vivar et al 7 reported that 31% of re-intubated subjects developed ventilator-associated pneumonia, and 21% developed sepsis. Re-intubated patients have longer ICU and hospital stays and increased transfer rates to long-term acute care facilities.…”

Section: Introductionmentioning

confidence: 99%

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Ventilator Liberation for High-Risk-for-Failure Patients: Improving Value of the Spontaneous Breathing Trial

2014

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Several patient populations have been identified as high risk for extubation failure despite successful completion of a spontaneous breathing trial (SBT). Extubation failure and subsequent need for emergent re-intubation have been associated with increased morbidity and mortality. In this review, we discuss ways to optimize the value and performance of the SBT in a subgroup of high-risk patients (elderly, cardiac, and/or respiratory failure) to reduce the rate of extubation failure. We recommend the use of T-piece mode, longer duration SBT, and measurement of the rapid shallow breathing index (breathing frequency/tidal volume in L) off ventilatory support to increase the predictive value of the SBT. In addition, measurement of changes in central venous oxygen saturation and serum brain natriuretic peptide, and measurements of mitral inflow and annular velocity using bedside transthoracic echocardiography with tissue Doppler imaging may help guide the clinician in determining who and when to extubate and thus minimize the rate of extubation failure. Arterial blood gas analysis performed at the end of the SBT may help determine who will benefit from prophylactic use of noninvasive ventilatory support postextubation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ventilator Liberation for High-Risk-for-Failure Patients: Improving Value of the Spontaneous Breathing Trial

2014

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“…Up to 10 -15% of the critically ill patients that are extubated need reintubation in the next 48 h (27). Moreover, reintubation is related to a worse outcome (8). In these preconditioned patients, the fine-tuning of the ventilatory parameters could be different than the previous settings.…”

Section: Sh3bgrl3mentioning

confidence: 99%

Exposure to mechanical ventilation promotes tolerance to ventilator-induced lung injury by Ccl3 downregulation

Blázquez-Prieto

López-Alonso

Amado-Rodríguez

et al. 2015

American Journal of Physiology-Lung Cellular and Molecular Phys

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Our objectives were to demonstrate that tolerance to VILI can be induced by previous low-pressure ventilation, and to identify the molecular mechanisms responsible for this phenomenon. Intact 8-to 12-wk-old male CD1 mice were preconditioned with 90 min of noninjurious ventilation [peak pressure 17 cmH2O, positive end-expiratory pressure (PEEP) 2 cmH2O] and extubated. Seven days later, preconditioned mice and intact controls were submitted to injurious ventilation (peak pressure 20 cmH2O, PEEP 0 cmH2O) for 2 h to induce VILI. Preconditioned mice showed lower histological lung injury scores, bronchoalveolar lavage albumin content, and lung neutrophilic infiltration after injurious ventilation, with no differences in Il6 or Il10 expression. Microarray analyses revealed a downregulation of Calcb, Hspa1b, and Ccl3, three genes related to tolerance phenomena, in preconditioned animals. Among the previously identified genes, only Ccl3, which encodes the macrophage inflammatory protein 1 alpha (MIP-1␣), showed significant differences between intact and preconditioned mice after high-pressure ventilation. In separate, nonconditioned animals, treatment with BX471, a specific blocker of CCR1 (the main receptor for MIP-1␣), decreased lung damage and neutrophilic infiltration caused by high-pressure ventilation. We conclude that previous exposure to noninjurious ventilation induces a state of tolerance to VILI. Downregulation of the chemokine gene Ccl3 could be the mechanism responsible for this effect.

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“…La identificación de este punto evolutivo es muy importante porque el intento de desvinculación prematuro condiciona el fracaso (con aumento de la mortalidad) (2) , y la desvinculación tardía expone al paciente a riesgo innecesario (3) . De esta manera, es fundamental contar con protocolos que regulen y homogeinicen el proceso de desvinculación, maximizando los beneficios de la AVM y evitando prolongar la asistencia más tiempo del necesario.…”

Section: Introductionunclassified

Prueba de ventilación espontánea en pacientes ventilados. Evaluación del cumplimiento de pautas protocolizadas contra análisis del equipo asistencial

Facciola

Martínez

Morgade

et al. 2017

RMU

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ResumenIntroducción: la duración ideal de la asistencia ventilatoria mecánica (AVM) genera debate e incertidumbre. El intento de desvinculación prematuro condiciona fracaso y aumento de mortalidad, mientras que la desvinculación tardía aumenta el riesgo del paciente. La utilización de pruebas de ventilación espontánea (PVE) son seguras e identifican aceptablemente a los pacientes listos para desvinculación. Sin embargo, la adherencia a pautas protocolizadas es muy variable y falla la implementación de evidencia científica a nivel clínico.Objetivo: analizar la interacción entre pautas de desvinculación de AVM y evaluación médica para la toma de decisiones.Material y método: trabajo descriptivo, prospectivo, con entrevista a médicos en la unidad de cuidados intensivos (UCI) sobre su valoración de la condición del paciente para realizar una PVE. Se comparó la opinión del médico con la evaluación hecha según protocolo de la UCI. Se analizaron coincidencias y discrepancias entre opinión de médicos y protocolo.Resultados: ingresaron 27 pacientes y 46 médicos. Las coincidencias representaron el 85,4% de las opiniones aunque existieron elementos de "confusión" en la decisión médica, tanto en coincidencias como en discrepancias. El más frecuente fue el estado de conciencia del paciente. Discusión y conclusiones: la valoración de la conciencia es fundamental para la asistencia diaria, pero no para la PVE. Su inclusión se vio involucrada en casi un tercio de las respuestas obtenidas, difiriendo la realización de la PVE. Este aspecto debe ser tenido en cuenta tanto para instancias docentes como asistenciales al momento de optimizar los tiempos para PVE y desvinculación de la AVM.

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Outcome of reintubated patients after scheduled extubation

Cited by 229 publications

References 26 publications

Ventilator Liberation for High-Risk-for-Failure Patients: Improving Value of the Spontaneous Breathing Trial

Ventilator Liberation for High-Risk-for-Failure Patients: Improving Value of the Spontaneous Breathing Trial

Exposure to mechanical ventilation promotes tolerance to ventilator-induced lung injury by Ccl3 downregulation

Prueba de ventilación espontánea en pacientes ventilados. Evaluación del cumplimiento de pautas protocolizadas contra análisis del equipo asistencial

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