Airway management relates to the period of tracheal intubation, maintenance of endotracheal tube in situ, and finally extubation. Problems related to difficult extubation still pose significant challenge for both anesthesiologists and intensivists. This article reviews current approach to extubation strategy following difficult intubation. Guidelines and algorithm may be helpful in order to ens...

BACKGROUND Respiratory distress syndrome remains a significant problem among premature infants. Mechanical ventilation through an endotracheal tube remains the mainstay of respiratory support but may be associated with lung injury and the development of chronic lung disease of prematurity. Efforts are needed to reduce the duration of mechanical ventilation in favour of less invasive forms of re...

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 ...

Background Identifying risk factors for unplanned extubation in patients receiving mechanical ventilation can help guide prevention strategies. Objective To assess the risk of unplanned extubation with different sedation strategies. Methods A 36-month quality improvement study in a 33-bed intensive care unit at a tertiary-care center. Results A total of 92 unplanned extubations occurred (7.5 ev...

BACKGROUND Continuous aspiration of subglottic secretions is effective in preventing ventilator-associated pneumonia, but it involves a risk of mucosal damage. The main objective of our study was to determine the incidence of airway complications related to continuous aspiration of subglottic secretions. METHODS In consecutive adult patients with continuous aspiration of subglottic secretions...

BACKGROUND While early extubation after coronary artery bypass grafting (CABG) has been associated with resource savings, its effect on patient outcomes remains unclear. The goal of the present investigation was to evaluate whether early extubation can be performed safely in elderly CABG patients in community practice. METHODS We studied 6,446 CABG patients, aged 65 years and older, treated a...

Background The weaning process is complex and needs to be done carefully. The success of extubation in premature babies is associated with brain maturity and adequate function of the lungs. We aimed to identify the ventilator parameters and clinical conditions related to extubation success and failure in premature infants. Materials and Methods This is anobservational study, analytical and non-...

HFNC therapy is increasingly used as ‘non-invasive’ respiratory support for preterm infants. A 2016 Cochrane Review found that had similar efficacy to NCPAP infants following extubation,1 but further studies were needed, particularly in extremely born <28 weeks' gestation, who are at highest risk of extubation failure. The trial by Uchiyama et al the largest randomised post-extubation infants, ...

objective neuromuscular disorders (diseases of the motor unit), can cause respiratory problems such as impaired cough reflex, chest deformity, recurrent pneumonia and acute respiratory failure; these are the worst most common complications of these diseases and the leading cause of death in such patients (1, 2). their management hence, very often, entails admission to the pediatric intensive ca...