Safely returning intubated, mechanically ventilated patients to independent breathing requires 3 steps.1,2 First, clinicians must recognize when respiratory failure has resolved or improved enough to allow a spontaneous breathing trial (SBT). Second, a 30–120 min SBT should be used to test the patient’s ability to breathe without the ventilator.3 Third, if the SBT is successful, the physician m...

The purpose of the study was to compare changes in oral health during intubation until 48 hours after extubation in neuroscience intensive care unit (ICU) patients enrolled in a standard or a comprehensive oral care protocol. The effects of manual toothbrushing (standard group, n = 31) were compared with those of tongue scraping, electric toothbrushing, and moisturizing (comprehensive group, n ...

OBJECTIVES To assess patient outcome following transthoracic (Ivor-Lewis) oesophagectomy and the effects of epidural analgesia and early extubation compared with overnight sedation and ventilation. DESIGN Retrospective study. SETTING University teaching hospital, Hong Kong. SUBJECTS AND METHODS A retrospective review of patients undergoing oesophagectomy during two periods, 1990 to 1994 (...

To avoid the complications associated with endotracheal intubation, noninvasive positive-pressure ventilation (NPPV) has been proposed in the management of ventilator weaning in patients with acute respiratory failure (ARF) of various etiologies. Several studies have been performed to assess the benefit of NPPV in various weaning strategies, including permitting early extubation in patients who...

BACKGROUND Unplanned extubations can result in serious complications. OBJECTIVES To determine characteristics of patients and nurses and risk factors that affect extubations. Methods A retrospective exploratory design was used. Ram-say Sedation Scale scores, need for reintubation, time between intubation and extubation, use of sedation and analgesia in the preceding 48 hours, and use of restr...

BACKGROUND AND OBJECTIVES: Unplanned extubation can be a significant event that places the patient at risk for adverse events. Our goal was to reduce unplanned extubations to,1 unplanned extubation per 100 patient-intubated days. METHODS: All unplanned extubations in the NICU beginning in October 2009 were audited. Data collected included time of day, patient weight, and patient care activity a...

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 (...

The aim of this study was to establish predictors for successfully planned extubation, which can be followed by medical personnel. The patients who were admitted to the adult intensive care unit of a tertiary hospital and met the following criteria between January 2005 and December 2014 were collected retrospectively: intubation > 48 hours; and candidate for extubation. The patient characterist...

Approximately 40% of patients admitted to the medical intensive care unit (ICU) require mechanical ventilation. An accurate prediction of successful extubation in patients is a key clinical problem in ICU due to the fact that the successful extubation is highly associated with prolonged ICU stay. The prolonged ICU stay is also associated with increasing cost and mortality rate in healthcare sys...

The search for ideal predictors of successful extubation or “liberation” from mechanical ventilation has been a subject of constant investigation for over half a century. Initial investigations were spurred by the need to determine adequate reversal of paralytic agents after general anesthesia, sufficient to allow sustained spontaneous ventilation and permit extubation.1,2 It is notable that th...