Indian Journal of Critical Care Medicine
Medknow Publications on behalf of the Indian Society of Critical Care Medicine
Vol. 12, No. 1, 2008, pp. 1-9
Bioline Code: cm08001
Full paper language: English
Document type: Review Article
Document available free of charge
Indian Journal of Critical Care Medicine, Vol. 12, No. 1, 2008, pp. 1-9
© Copyright 2008 Indian Journal of Critical Care Medicine.
Extubation failure in intensive care unit: Predictors and management|
Kulkarni, Atul P & Agarwal, Vandana
Extubation failure-need for reintubation within 72 h of extubation, is common in intensive care unit (ICU). It can cause increased morbidity, higher costs, higher ICU and hospital length of stay (LOS) and mortality. Patients with advanced age, high severity of illness at ICU admission and extubation, preexisting chronic respiratory and cardiovascular disorders are at increased risk of extubation failure. Unresolved illness, development and progression of organ failure during the time from extubation to reintubation and reintubation itself have been proposed as reasons for increased morbidity and mortality. Parameters used to predict extubation failure can be categorized into parameters assessing respiratory mechanics, airway patency and protection and cardiovascular reserve. Adequate cough strength, minimal secretions and alertness are necessary for successful extubation. Evidence suggests that early institution of non-invasive ventilation and prophylactic administration of methylprednisolone may prevent reintubation in some patients. The intensivist needs to identify patients at high risk of extubation failure and be prepared to reinstitute ventilation early to prevent adverse outcomes.
Extubation, failure of, predictors of, reintubation, weaning
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