The Decision to Extubate in the Intensive Care Unit.
Am J Respir Crit Care Med. 2013 May 3;
Authors: Thille AW, Richard JC, Brochard L
Abstract (164 words) The day of extubation is a critical time during an intensive care unit (ICU) stay. Extubation is usually decided after a weaning readiness test involving either spontaneous breathing on a T-piece or low levels of ventilatory assist. Extubation failure occurs in 10% to 20% of patients and is associated with extremely poor outcomes including high mortality rates of 25% to 50%. There is some evidence that extubation failure can directly worsen patient outcomes independently of underlying illness severity. Understanding the pathophysiology of weaning tests is essential given their central role in extubation decisions, yet very few studies have investigated this point. Because extubation failure is relatively uncommon, randomized controlled trials on weaning are underpowered to address this issue. Moreover, most studies evaluated patients at low risk for extubation failure, whose reintubation rates were about 10% to 15%, whereas several studies identified high-risk patients with extubation failure rates exceeding 25% or 30%. Strategies for identifying patients at high risk for extubation failure are essential to improve the management of weaning and extubation. Two preventive measures may prove beneficial, although their exact role needs confirmation: one is non-invasive ventilation after extubation in high-risk or hypercapnic patients and the other is steroid administration several hours before extubation. These measures might help to prevent post-extubation respiratory distress in selected patient subgroup.
PMID: 23641924 [PubMed - as supplied by publisher]