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...

a study published in the previous issue of Critical Care, Gonçalves and colleagues [1] observed a 33% reduction in re-intubation rate in the study group, due to eff ective management of bronchial secretions. Current evidence favors early implementation of noninvasive mechanical ventilation (NIV) in the post-extubation period to reduce re-intubation, especially in patients with hypercapnic respi...

OBJECTIVE To develop additional criteria to predict for successful extubation of very-low-birth-weight infants recovering from respiratory distress syndrome. DESIGN Prospective study. SETTING Neonatal intensive care unit at a university teaching hospital. INTERVENTIONS Infants ready for extubation according to clinical, ventilatory and blood gas criteria were studied. Before extubation, t...

BACKGROUND Remifentanil and dexmedetomidine are well known to suppress airway reflexes during airway procedures. Smooth tracheal extubation is important after otologic surgery. The purpose of this study is to compare the effectiveness of dexmedetomidine or remifentanil infusion for producing smooth tracheal extubation in deeply anesthetized patients after otologic surgery. METHODS Seventy-fou...

Methods Prospective collected database was conducted from December 2014 to April 2015. Weak cough was defined by peak expiratory flow (PEF) < 60 L/min. The PEF was measured with Cosmed Pony Graphic spirometer v.4.0 S-CZ before extubation, for the patients mechanically ventilated >24 h, who passed successfully SBT at least of 30 min of pressure support 5-8 cmH2O, CPAP, or T-T. The patients were ...

BACKGROUND Economics has caused the trend of early tracheal extubation after cardiac surgery, yet no prospective randomized study has directly validated that early tracheal extubation anesthetic management decreases costs when compared with late extubation after cardiac surgery. METHODS This prospective, randomized, controlled clinical trial was designed to evaluate the cost savings of early ...