Introduction Extubation failure in critically ill patients has associated morbidity, but it cannot be safely predicted or avoided. Preventive NIMV has proved beneficial only in hypercapnic patients. We hypothesized that High-flow oxygen therapy may reduce postextubation respiratory failure due to gas humidification, avoidance of lung collapse by moderate PEEP, and work of breathing reduction by...

OBJECTIVES To assess whether the combination of daily evaluation and use of a spontaneous breathing test could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasive ventilation. DESIGN A prospective, randomized controlled trial. SETTING Two pediatric inte...

OBJECTIVE To determine the factors that predict outcome of noninvasive ventilation (NIV) in critically ill children. DESIGN Prospective observational study. SETTING Multidisciplinary pediatric intensive care unit of a university hospital in Malaysia. PATIENTS Patients admitted to the pediatric intensive care unit from July 2004 to December 2006 for respiratory support due to acute respira...

BACKGROUND Sedation and/or analgesia can relieve the patient-ventilator asynchrony. However, whether sedation and/or analgesia can benefit the clinical outcome of the patients with interface intolerance is still unclear. METHODS A retrospective study was performed on patients with interface intolerance who received noninvasive positive pressure ventilation (NIPPV) after extubation in seven in...

STUDY OBJECTIVE To determine whether spinal muscular atrophy (SMA) type 1 can be managed without tracheostomy and to compare extubation outcomes using a respiratory muscle aid protocol vs conventional management. DESIGN A retrospective cohort study. METHODS Eleven SMA type 1 children were studied during episodes of respiratory failure. Nine children required multiple intubations. Along with...

We read with great interest the article by Bach et al 1 in a recent issue of CHEST (May 2010) concerning the application of continuous volume-cycled noninvasive ventilation (NIV) and mechanically assisted coughing (MAC) to successfully extubate patients with neuromuscular disease (NMD) after an episode of acute respiratory failure (ARF). In fact, considering that extubation failure is associate...

Despite a thorough weaning assessment, including a spontaneous breathing trial (SBT), liberation from mechanical ventilation via endotracheal extubation is associated with re-intubation rates of up to 24%.1 Re-intubation, in turn, is associated with an increased risk of mortality, intensive care unit (ICU) stay, need for transfer to longterm care facility,2 and nosocomial pneumonia.3 Avoiding r...

Methods Prospective observational study completed from April 2013 to April 2015. Including adult patients with mechanical ventilation form more than 24 hours that met the international consensus conference criteria. Patients with less than 18 years old or those with the order of limiting therapeutic effort. Discontinuation from mechanical ventilation was attempted at clinical judgment of the me...

1. Davila VR, Schwab C, Papadimos TJ, Casabianca AB. A difficult extubation: Endotracheal tube ensnarement by a Kirschner wire. Int J Crit Illn Inj Sci 2015;5:128-9. 2. Dryden GE. Circulatory collapse after pneumonectomy (an unusual complication from the use of a Carlens catheter): Case report. Anesth Analg 1977;56:451-2. 3. Suresh YV, Mehandale SG, Vijesh KS. Difficult extubation – A case repo...

INTRODUCTION Weaning protocols that include noninvasive ventilation (NIV) decrease re-intubation rates and ICU length of stay. However, impaired airway clearance is associated with NIV failure. Mechanical insufflation-exsufflation (MI-E) has been proven to be very effective in patients receiving NIV. We aimed to assess the efficacy of MI-E as part of an extubation protocol. METHOD Patients wi...