Extubation failure: magnitude of the problem, impact on outcomes, and prevention.
Curr Opin Crit Care
; 9(1): 59-66, 2003 Feb.
Article
em En
| MEDLINE
| ID: mdl-12548031
ABSTRACT
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, encephalopathy, and cardiac dysfunction. Compared with patients who tolerate extubation, those who require reintubation have a higher incidence of hospital mortality, increased length of ICU and hospital stay, prolonged duration of mechanical ventilation, higher hospital costs, and an increased need for tracheostomy. Given the lack of proven treatments for extubation failure, clinicians must be aware of the factors that predict extubation outcome to improve clinical decision making. Risk factors for extubation failure include being a medical, multidisciplinary, or pediatric patient; age greater than 70 years; a longer duration of mechanical ventilation; continuous intravenous sedation; and anemia. Tests designed to assess for upper airway obstruction, secretion volume, and the effectiveness of cough can help to improve prediction of extubation failure. Rapid reinstitution of ventilatory support in patients who fail extubation may improve outcome.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Desmame do Respirador
/
Intubação Intratraqueal
Tipo de estudo:
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Curr Opin Crit Care
Assunto da revista:
TERAPIA INTENSIVA
Ano de publicação:
2003
Tipo de documento:
Article
País de afiliação:
Estados Unidos