Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation.

Torres, Antoni; Gatell, Josep M.; Aznar, Elena Guadalupe Corella; El-Ebiary, Mustafa; Bellacasa, Jorge Puig de la; González, J.; Ferrer, Miguel; Rodríguez-Roisín, Robert

doi:10.1164/ajrccm.152.1.7599812

Cited by 464 publications

(260 citation statements)

References 10 publications

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“…Other studies have reported that extubation failure increases the risk of pulmonary complications, mortality, duration of MV, and an increased length of ICU stay (5,6,17). The need for reintubation is a risk factor for the development of pulmonary infection (5,18,19) because it favors bronchoaspiration and alterations in mucociliary clearance, which may lead to bacterial contamination and colonization of the airways (14,20).…”

Section: Discussionmentioning

confidence: 99%

“…The need for reintubation is a risk factor for the development of pulmonary infection (5,18,19) because it favors bronchoaspiration and alterations in mucociliary clearance, which may lead to bacterial contamination and colonization of the airways (14,20). Also, extubation failure is directly related to altered level of consciousness (2), probably due to the fact that patients with a lower level of consciousness exhibit large amounts of secretions, cough deficiency and swallowing deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…This condition occurs in 2 to 25% of extubated patients (1)(2)(3). Extubation failure increases the incidence of mortality, pneumonia, number of days in the intensive care unit (ICU) and hospital, time spent on mechanical ventilation (MV), hospital costs, and the need for a tracheostomy (4)(5).…”

Section: Introductionmentioning

confidence: 99%

“…A number of studies have demonstrated an increased incidence of reintuba-tion, pneumonia, and prolonged MV among such patients (2)(3)(4)(5)7,9,14,15).…”

Section: Introductionmentioning

confidence: 99%

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Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery

Vidotto

Sogame

Gazzotti

et al. 2011

Braz J Med Biol Res

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48 h) until discharge from the hospital or death. The occurrence of PPC, incidence of death, the need for reoperation and tracheostomy, and the length of hospitalization were assessed during the postoperative period. Twenty-six patients (8.2%) experienced extubation failure and 30 (9.5%) needed prolonged MV after surgery. Multivariate analysis showed that extubation failure was significant for the occurrence of death (OR = 8.05 [1.88; 34.36]), PPC (OR = 11.18 [2.27; 55.02]) and tracheostomy (OR = 7.8 [1.12; 55.07]). Prolonged MV was significant only for the occurrence of PPC (OR = 4.87 [1.3; 18.18]). Elective intracranial surgery patients who experienced extubation failure or required prolonged MV had a higher incidence of PPC, reoperation and tracheostomy and required a longer period of time in the ICU. Level of consciousness and extubation failure were associated with death and PPC. Patients who required prolonged MV had a higher incidence of extubation failure.]]>

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…A number of studies have demonstrated an increased incidence of reintuba-tion, pneumonia, and prolonged MV among such patients (2)(3)(4)(5)7,9,14,15).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery

Vidotto

Sogame

Gazzotti

et al. 2011

Braz J Med Biol Res

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“…Appropriate securing of tracheal tubes and the prevention of the need for reintubations may reduce the risk of VAP [88].…”

Section: Unplanned Extubationsmentioning

confidence: 99%

Ventilator‐associated pneumoniaDiagnosis, pathogenesis and prevention

Young¹,

Ridley²

1999

Anaesthesia

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SummaryVentilator-associated pneumonia is common, difficult to diagnose, affects the most vulnerable of patients and carries a high mortality. During prolonged mechanical ventilation the oropharynx, sinuses, dentition and stomach of critically ill patients become colonised with pathogenic bacteria. Colonised secretions pool in the oropharynx and subglottic space. These secretions repeatedly gain access to the lower airways by leakage past the tracheal tube cuff. If host defence mechanisms are overwhelmed, multiplication occurs in the lower respiratory tract producing an inflammatory response in the bronchioles and alveoli. The inflammatory response is characterised by capillary congestion, leucocyte and macrophage infiltration and fibrinous exudation into the alveolar spaces. If this inflammatory response occurs more than 48 h after intubation, it is called ventilatorassociated pneumonia. Prevention depends on reducing upper airway and gastrointestinal reservoirs of bacteria, reducing or abolishing aspiration of these bacteria past the tracheal tube cuff and enhancing bacterial clearance from the lower airways. Despite an increased understanding of the pathogenesis and diagnosis of ventilator-associated pneumonia (VAP), prevention has remained problematic. There is now good evidence for continuous leakage of infected secretions past the tracheal tube cuff being responsible for VAP. As a result, VAP strikes critically ill patients and increases their morbidity and mortality. The aim of this review is to discuss the diagnosis and pathogenesis of VAP, including a brief review of natural defence mechanisms. The review also covers the prevention of VAP with special reference to new developments aimed at reducing aspiration past the cuff. Definition

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Ventilator-Associated Pneumonia

Morehead¹,

Pinto²

2000

Arch Intern Med

109

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Ventilator-associated pneumonia is a common complication in intensive care units, occurring in 9% to 24% of patients intubated for longer than 48 hours. Because of this large disease burden and the resultant attributable morbidity and mortality, there is great interest in accurately diagnosing, treating, and preventing this complication. More severely ill patients tend to develop ventilator-associated pneumonia, and identified risk factors include prolonged mechanical ventilation, reintubation after failed extubation, and a few other clinical variables. The efficacy of diagnostic and preventive strategies is somewhat controversial. Diagnosis by invasive methods requires a considerable commitment of resources but can potentially reduce cost of care; however, mortality benefit from this approach has not been demonstrated. As such, in most institutions, ventilator-associated pneumonia is best diagnosed using traditional clinical criteria. Prompt administration of appropriate antibiotics seems to be the only intervention that alters outcome once the diagnosis is established. Several strategies seem to reduce pneumonia incidence; however, mortality and cost benefits have yet to be convincingly shown.

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Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation.

Cited by 464 publications

References 10 publications

Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery

Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery

Ventilator‐associated pneumoniaDiagnosis, pathogenesis and prevention

Ventilator-Associated Pneumonia

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