emergence from general anesthesia can be associated with coughing, agitation, and hemodynamic disturbances. remifentanil may attenuate these responses. we have examined the effect of remifentanil on the hemodynamic response to the emergence from anesthesia and tracheal extubation. in a double-blind, randomized trial, we enrolled 50 adult patients undergoing abdominal surgery. all patients recei...

Background:  Successful weaning of the ventilator is a major challenge, especially in children. This study was conducted to compare the criteria of readiness for extubation and daily spontaneous breathing test (SBT) on the duration of mechanical ventilation and extubation failure rates. Materials and Metho...

OBJECTIVES To determine the incidence of extubation failure in preterm newborns with birth weight < 1,250 g extubated to nasal continuous positive airway pressure and to identify the main risk factors associated with the need for reintubation in this population. METHODS A retrospective review of eligible infants admitted and mechanically ventilated between July 2002 and June 2004 was performe...

background: extubation is associated with the risk of complications such as accumulated secretion above the endotracheal tube cuff, eventual atelectasia following a reduction in pulmonary volumes because of a lack of physiological positive end expiratory pressure, and intra-tracheal suction. in order to reduce these complications, and, based on basic physiological principles, a new practical ex...

BACKGROUND/AIMS Both diaphragmatic excursion and change in muscle thickening are measured using ultrasonography (US) to assess diaphragm function and mechanical ventilation weaning outcomes. However, which parameter can better predict successful extubation remains to be determined. The aim of this study was to compare the clinical utility of these two diaphragmatic parameters to predict extubat...

A crucial step in the transition from mechanical ventilation to extubation is the successful performance of a spontaneous breathing trial (SBT). The American College of Chest Physicians (ACCP) Guidelines recommend removal of the endotracheal tube upon successful completion of a SBT. However, this does not guarantee successful extubation as there remains a risk of re-intubation. Guidelines have ...

In recent years, there has been increasing interest in the use of noninvasive ventilation (NIV) in the post-extubation period to shorten the length of invasive ventilation, to prevent extubation failure, and to rescue a failed extubation. The purpose of this review is to summarize the evidence related to the use of NIV in these settings. NIV can be used to allow earlier extubation in selected ...

BACKGROUND Unplanned extubation represents a threat to patient safety, and risk factors and prevention strategies for unplanned extubation have not been fully explored. OBJECTIVES To define high-risk patients for unplanned extubation and determine clinicians' beliefs on perceived risks for unplanned extubation METHODS With a Web-based survey instrument we surveyed critical care clinician me...

BACKGROUND Post-extubation stridor occurs after translaryngeal intubation results to re-intubation in a number of patients. OBJECTIVE To determine the cut-off value of the cuff leak volume test among Thai patients as a predictor for post-extubation stridor MATERIAL AND METHOD Demographic data and cuff leak volume were collected from patients who had been intubated with planned extubation. C...

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...