Post-extubation stridor and upper-airway obstruction are multifactorial in etiology and can occur as a result of laryngotracheal edema, intubation trauma, excessive cuff pressure with mucosal ulceration, and prolonged intubation with secondary inflammation and granuloma formation.1 Cuff leak tests (CLTs) were introduced in an attempt to predict post-extubation upper-airway obstruction and reduc...

OBJECTIVE To update the state of knowledge on unplanned extubations (UEs) in neonatal ICUs. This review focuses on the following topics: incidence, risk factors, reintubation after UE, outcomes, and prevention. METHODS The MEDLINE, EMBASE, CINAHL, Scielo, Lilacs, and Cochrane databases were searched for relevant publications from January 1, 1950, through January 30, 2012. Fifteen articles wer...

AIM To determine if a weaning regimen on flow driver continuous positive airway pressure (CPAP) would decrease the number of ventilator days but increase the number of CPAP days when compared with a rescue regimen. METHODS Fifty eight babies of 24-32 weeks gestation with respiratory distress syndrome (RDS) were studied prospectively. After extubation they were randomly allocated to receive CP...

AIMS AND OBJECTIVES We used near-infrared spectroscopy to document changes in cerebral tissue oxygen saturation (SctO2) in response to ventilation mode alterations after bidirectional Glenn (BDG; superior cavopulmonary connection) procedure. We also determined whether spontaneous ventilation have a beneficial effect on hemodynamic status, lactate and SctO2 when compared with other ventilation m...

OBJECTIVE To evaluate demographic characteristics, mechanical-ventilation parameters, blood gas values, and ventilatory indexes as predictors of extubation failure in infants with severe acute bronchiolitis. METHODS We conducted a prospective observational study from March 2004 to September 2005 with consecutive infants (ages 1-12 months) with severe acute bronchiolitis and considered ready t...

Intubation of the left main bronchus via a tracheostomy tube was performed in a patient with local recurrence of lung cancer associated with invasion and obstruction of the left main bronchus after right sleeve pneumonectomy. The result was satisfactory not only for preventing asphyxia, but also for maintaining the patency of the airway after extubation of the endotracheal tube.

INTRODUCTION The aim of the present study was to investigate the effects of the stress response on plasma insulin, cortisol, glucose, and urinary vanilmandelic acid during weaning and after extubation, using pressure support (PS), continuous positive airway pressure (CPAP) and T-piece modes. METHODS Sixty patients were randomly divided into three groups (n = 20). The PS group received FiO2 </...

BACKGROUND The ventilatory capacity of the respiratory neuromuscular system can be studied with the hypercapnia test. OBJECTIVE To determine whether decreased response to the hypercapnia test is associated with failure to pass a spontaneous breathing trial (SBT) or extubation failure. METHODS We studied 103 intubated patients ready for SBT. We used a hypercapnia test in which we approximate...

OBJECTIVE To assess the value of a spontaneous breathing trial (SBT) using a flow-inflating bag in predicting extubation success. Secondary goals were to evaluate the positive and negative predictive accuracy of a 15-min SBT. DESIGN Prospective, blinded, clinical study. SETTING Pediatric intensive care unit (ICU) of a university hospital PATIENTS Infants and children intubated for >or=24 ...

discussion the vigilance and experience of medical personnel in the icu, appropriate iv sedation, and using a bite block are the best ways to prevent mortality caused by aspiration of an ett in all intubated patients. case presentation we report a case of death caused by tracheal tube aspiration, where it was located distal to the vocal cords, with a part of it entering the right bronchus and t...