Extubation failure, defined as the need for reinstitution of ventilatory support within 24 to 72 hours of planned endotracheal tube removal, occurs in 2 to 25% of extubated patients. The pathophysiologic causes of extubation failure include an imbalance between respiratory muscle capacity and work of breathing, upper airway obstruction, excess respiratory secretions, inadequate cough, encephalo...

Background. Automatic tube compensation (ATC) has been developed to overcome the imposed work of breathing due to artificial airways during spontaneous breathing trials (SBTs). Objectives. This study aimed to assess extubation outcome after an SBT (spontaneous breathing trial) with ATC compared with pressure support ventilation (PSV) and to determine the risk factors for extubation failure. Met...

Purpose: To investigate the pulmonary outcomes of early extubation (within the first 24 hours of life) with synchronized nasal intermittent positive pressure ventilation (NIPPV) in extremely premature infants born at 25–26 weeks’ gestation. Methods: Medical records of extremely premature infants (gestational age: 25–26 weeks) born and admitted to the Keimyung University Dongsan Medical Center b...

OBJECTIVE A systematic review of weaning and extubation for pediatric patients on mechanical ventilation. DATA SELECTION Pediatric and adult literature, English language. STUDY SELECTION Invited review. DATA SOURCES Literature review using National Library of Medicine PubMed from January 1972 until April 2008, earlier cross-referenced article citations, the Cochrane Database of Systematic...

Results Out of 680 intubations, 73(11%) patients [46 (63%) male] had failed extubations. Average age was 60(21-88) years. Average time to re-intubation was 22.1(1-72) hours, 45(62%) being re-intubated at≤24 hours. Average time intubated was 2.2 days with 3 patients intubated for >7 days. Fifteen(21%) patients had had no sedation within 4 hours of extubation. All others had one or more of fentan...

RET 2.0 DESCRIPTION/DEFINITION The decision to discontinue mechanical ventilation involves weighing the risks of prolonged mechanical ventilation against the possibility of extubation failure.1,2 This guideline will focus on the predictors that aid the decision to extubate, the procedure referred to as extubation, and the immediate postextubation interventions that may avoid potential reintubat...

Respiratory complications after tracheal extubation are associated with significant morbidity and mortality, suggesting that process improvements in this clinical area are needed. The decreased rate of respiratory adverse events occurring during tracheal intubation since the implementation of guidelines for difficult airway management supports the value of education and guidelines in advancing ...

BACKGROUND The efficacy of corticosteroids in reducing the incidence of postextubation laryngeal oedema is controversial. We aimed to test our hypothesis that methylprednisolone started 12 h before a planned extubation could prevent postextubation laryngeal oedema. METHODS We did a placebo-controlled, double-blind multicentre trial in 761 adults in intensive-care units. Patients who were vent...