Extubation failure is usually defined as the need for reintubation within 48–72 h following extubation [1]. Patients may be unable to maintain spontaneous breathing for multiple reasons: increased workload of breathing, cardiovascular dysfunction, airway obstruction, or excessive secretions. The incidence of post-extubation respiratory failure ranges between 10 and 20 % [2]. Patients who fail extubation have higher mortality, consistently reported at about 20–50 % in intensive care units (ICUs), and longer ICU and hospital stays [3]. Reintubation is a risk factor for ventilator-associated pneumonia [4] and is independently associated with ICU mortality [3, 5, 6]. A minority of reintubated patients die in the first 24 h after reintubation, whereas mortality increases with time to reintubation [7]. Moreover, upper-airway obstruction is the reason for reintubation in about 5–15 % of cases, but no increase in mortality has been reported in this population [7]. Thus, three scenarios explain the higher mortality rate: (1) reintubation entails risks per se, (2) it is a marker for severity of illness, or (3) it is a consequence of a new event occurring between extubation and reintubation.

Monitoring and Mechanical Ventilator Setting During Noninvasive Mechanical Ventilation: Key Determinants in Post-extubation Respiratory Failure / D. Chiumello, F. Di Marco, S. Centanni, C. Mietto - In: Noninvasive Mechanical Ventilation and Difficult Weaning in Critical Care : Key topics and Practical Approaches / [a cura di] A.M. Esquinas. - [s.l] : Springer, 2016. - ISBN 9783319042596. - pp. 95-109 [10.1007/978-3-319-04259-6_13]

Monitoring and Mechanical Ventilator Setting During Noninvasive Mechanical Ventilation: Key Determinants in Post-extubation Respiratory Failure

D. Chiumello;F. Di Marco;S. Centanni;C. Mietto
2016

Abstract

Extubation failure is usually defined as the need for reintubation within 48–72 h following extubation [1]. Patients may be unable to maintain spontaneous breathing for multiple reasons: increased workload of breathing, cardiovascular dysfunction, airway obstruction, or excessive secretions. The incidence of post-extubation respiratory failure ranges between 10 and 20 % [2]. Patients who fail extubation have higher mortality, consistently reported at about 20–50 % in intensive care units (ICUs), and longer ICU and hospital stays [3]. Reintubation is a risk factor for ventilator-associated pneumonia [4] and is independently associated with ICU mortality [3, 5, 6]. A minority of reintubated patients die in the first 24 h after reintubation, whereas mortality increases with time to reintubation [7]. Moreover, upper-airway obstruction is the reason for reintubation in about 5–15 % of cases, but no increase in mortality has been reported in this population [7]. Thus, three scenarios explain the higher mortality rate: (1) reintubation entails risks per se, (2) it is a marker for severity of illness, or (3) it is a consequence of a new event occurring between extubation and reintubation.
Continuous Positive Airway Pressure; Chronic Obstructive Pulmonary Disease Patient; Pressure Support Ventilation; Spontaneous Breathing Trial; Extubation Failure
Settore MED/41 - Anestesiologia
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/633274
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