Predictors of Extubation Success in Patients with Posterior Fossa Strokes

Guru, Pramod; Singh, Thakar; Pedavally, Swetha; Rabinstein, Alejandro A.; Hocker, Sara E.

doi:10.1007/s12028-016-0249-7

Cited by 18 publications

(14 citation statements)

References 17 publications

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“…This result was similar to other studies that estimate that the process of MV removal takes up about half of the total time of ventilatory support (40)(41)(42) . However, both the weaning time and the total MV time, concerning the date of intubation until the day of extubation, did not show statistically significant differences between the groups.…”

Section: Discussionsupporting

confidence: 92%

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

Silva

Tonelli²,

Costa³

et al. 2020

Rev. Latino-Am. Enfermagem

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Objective: to clinically validate the nursing diagnosis of Dysfunctional Ventilatory Weaning Response in adult patients admitted to Intensive Care Units. Method: a concurrent cohort performed with 93 patients admitted to Intensive Care Units. The incidence and incidence density of the diagnosis were estimated, its related factors were identified based on bivariate analysis and clinical indicators for determining its occurrence, according to the global and temporal presentation. Results: the overall incidence of the diagnosis was 44.09% and the incidence density was 14.49 occurrences for every 100 extubations/day. The factors related to the diagnosis were the following: age, clinical severity, fluid balance, oliguria, hemodialysis, edema in upper/lower limbs, anasarca, number of antibiotics, hypothermia, hyperthermia, amount of secretion, muscle retraction, anxiety score, heart rate, use of vasopressors and non-invasive ventilation after extubation. The clinical indicators most frequently identified for determining the diagnosis were the following: tachypnea, drop of saturation and tachycardia. Temporal progression in the severity of these manifestations was found. Conclusion: the Dysfunctional Ventilatory Weaning Response is a common finding in critically ill patients. Some components of the diagnosis of the NANDA-International (2018) version could be clinically validated. It is noteworthy that there are variables not yet described in the taxonomy, demonstrating the need to review this nursing diagnosis.

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Section: Discussionsupporting

confidence: 92%

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

Silva

Tonelli²,

Costa³

et al. 2020

Rev. Latino-Am. Enfermagem

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“…By delaying extubation in the late tracheostomy group in our study, physicians hoped to increase the success rate of extubation (Table 1). Ventilated brain-injured patients are often affected by delayed extubation, as weaning is generally successful; however, extubation fails in approximately 30-40% of cases [21][22][23]. Namen et al found that neurosurgical patients with GCS scores ≥ 8 at extubation were associated with a 75% extubation success rate, increasing 39% for each improvement point [24].…”

Section: Discussionmentioning

confidence: 99%

The impact of tracheostomy timing on clinical outcomes and adverse events in intubated patients with infratentorial lesions: early versus late tracheostomy

Huang

Zhang

et al. 2020

Neurosurg Rev

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We evaluated the association between the timing of tracheostomy and clinical outcomes in patients with infratentorial lesions. We performed a retrospective observational cohort study in a neurosurgical intensive care unit (ICU) at a tertiary academic medical center from January 2014 to December 2018. Consecutive adult patients admitted to the ICU who underwent resection of infratentorial lesions as well as tracheostomy were included for analysis. Early tracheostomy was defined as performed on postoperative days 1-10 and late tracheostomy on days 10-20 after operation. Univariate and multivariate analyses were used to compare the characteristics and outcomes between both cohorts. A total of 143 patients were identified, and 96 patients received early tracheostomy. Multivariable analysis identified early tracheostomy as an independent variable associated with lower occurrence of pneumonia (odds ratio, 0.25; 95% CI, 0.09-0.73; p = 0.011), shorter stays in ICUs (hazard ratio, 0.4; 95% CI, 0.3-0.6; p = 0.03), and earlier decannulation (hazard ratio, 0.5; 95% CI, 0.4-0.8; p = 0.003). However, no significant differences were observed between the early and late tracheostomy groups regarding hospital mortality (p > 0.999) and the modified Rankin scale after 6 months (p = 0.543). We also identified postoperative brainstem deficits, including cough, swallowing attempts, and extended tongue as well as GCS < 8 at ICU admission as the risk factors independently associated with patients underwent tracheostomy. There is a significant association between early tracheostomy and beneficial clinical outcomes or reduced adverse event occurrence in patients with infratentorial lesions.

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“…In a review article by Guru et al, a depressed level of consciousness, and not a ventilatory or oxygenation disorder, was the most common indication for MV support. [20][21][22] Some conditions, especially neuromuscular weaknesses, can result in very long durations of MV in patients who do not appear acutely ill. As such, these individuals may be hard to identify using existing models and for these well recognized conditions, such as GBS, 89% of these patients will require PMV. 23 These well-known neuromuscular diseases may represent an independent predictor in itself for PMV and rarely fit into this model.…”

Section: Discussionmentioning

confidence: 99%

I-TRACH: Validating A Tool for Predicting Prolonged Mechanical Ventilation

Clark

Inocencio

Lettieri

2016

J Intensive Care Med

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Predictors of Extubation Success in Patients with Posterior Fossa Strokes

Abstract: In posterior fossa stroke patients with a GCS ≤ 6 at the time of intubation and who remain intubated for more than 1 week, extubation is less likely to be successful, and tracheostomy should be considered.

Cited by 18 publications

References 17 publications

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

The impact of tracheostomy timing on clinical outcomes and adverse events in intubated patients with infratentorial lesions: early versus late tracheostomy

I-TRACH: Validating A Tool for Predicting Prolonged Mechanical Ventilation

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