Association of Extubation Failure and Functional Outcomes in Patients with Acute Neurologic Illness

Rishi, Muhammad Adeel; Kashyap, Rahul; Wilson, Gregory; Schenck, Louis A.; Hocker, Sara E.

doi:10.1007/s12028-015-0156-3

Cited by 20 publications

(12 citation statements)

References 33 publications

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“…In the present study, EF occurred with a relatively low ratio of 0.14, compared with the rates between 0.11 and 0.44 reported in the previously published studies (Anderson et al, 2011;Guru et al, 2016;Karanjia et al, 2011;Rishi et al, 2016;Steidl et al, 2017). Advanced age has been proven to be an important factor associated with an increased risk of EF.…”

Section: Discussioncontrasting

confidence: 58%

Extubation timing and risk of extubation failure in aneurysmal subarachnoid hemorrhage patients

Yang

Zhao

et al. 2022

Preprint

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Background The extubation time is critical during the intensive care unit stay in aneurysmal subarachnoid hemorrhage (aSAH) patients.The current conventional parameters for predicting extubation failure (EF) and extubation time may not be suitable for this population. Here, we aimed to identify factors associated with EF in aSAH patients. Methods From a single-center observational study on aSAH patients with computed tomography angiography from 2019 to 2021, patients who received microsurgery were enrolled and divided into two groups according to whether EF occurred. Multivariable logistic regression was conducted to evaluate disease severity, medical history, and extubation time differences between patients with and without EF. Results Of 335 patients included, EF occurred with a rate of 0.14. The delayed cerebral ischemia (67.4% vs. 13.5%) and acute hydrocephalus (6.5% vs. 1.4%) were frequently observed in patients with EF. Also, patients who develop EF presented higher disability (65.9% vs. 17.4%) and mortality (10.9% vs. 0.7%) rates. A multivariable analysis demonstrated that age (OR 1.038; 95%CI: 1.004–1.073;P = 0.028), onset to admission time (OR 0.731; 95%CI: 0.566–0.943;P = 0.016), WNFS grade > 3 (OR 4.309; 95%CI: 1.639–11.330;P = 0.003), and extubation time < 24 h (OR 0.097; 95%CI: 0.024–0.396;P = 0.001) were significantly associated with EF occurrence. Conclusions These data provide further evidence that older aSAH patients with onset to admission time < 2days and WFNS grade > 3 have a high risk of developing EF, which is amplified by the ultra-early extubation. Moreover, in patients with two or more risk factors, a prolonged intubation recommendation requires consideration to avoid the EF.

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Section: Discussioncontrasting

confidence: 58%

Extubation timing and risk of extubation failure in aneurysmal subarachnoid hemorrhage patients

Yang

Zhao

et al. 2022

Preprint

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“…For example, 83% of those with scores greater than 10 failed extubation at least once before TR in our cohort. It is noteworthy that extubation failure especially increases LOS and VD and might put the patient at higher risk of morbidity, aspiration pneumonia [21], and even mortality [22].…”

Section: Discussionmentioning

confidence: 99%

Predictors for Tracheostomy with External Validation of the Stroke-Related Early Tracheostomy Score (SETscore)

et al. 2018

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“…Nevertheless, the timing of extubation has become imperative. Patients who required reintubation after premature extubation tended to have poor prognosis, increased mortality, longer ICU lengths of stay, higher rates of required tracheotomies, and poorer functional outcome after recovery . Therefore, the prevention of extubation failure after a critical illness is an issue of considerable importance to public health.…”

Section: Introductionmentioning

confidence: 99%

Chest physiotherapy with early mobilization may improve extubation outcome in critically ill patients in the intensive care units

Wang

2018

Clinical Respiratory J

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Background: Extubation failure can lead to a longer intensive care unit (ICU) stay, higher mortality rate, and higher risk of requiring tracheostomy. Chest physiotherapy (CPT) can help patients in reducing the accumulation of airway secretion, preventing collapsed lung, improving lung compliance, and reducing comorbidities. Much research has investigated the correlation between CPT and respiratory system clearance. However, few studies have investigated the correlation between CPT and failed ventilator extubation. Therefore, this study aimed to investigate the use of CPT for reducing the rate of failed removal from mechanical ventilators. Methods: This study was an intervention study with mechanical control. Subjects were divided into two groups. The control group, which received routine nursing chest care, was selected from a retrospective chart review. The intervention group was prospectively taken into the chest physiotherapy program. The chest physiotherapy treatment protocol consisted of inspiratory muscle training, manual hyperinflation, chest wall mobilization, secretion removal, cough function training, and early mobilization. Results: A total of 439 subjects were enrolled in the intervention and control groups, with a mean age of 69 years. APACHE II score (P = .09) and GCS scores (P = .54) were similar between the two groups. Compared to the control group, patients in the intervention group had a significantly lower reintubation rate (8% vs 16%; P = .01). Conclusions:The results indicate that intensive chest physiotherapy could decrease extubation failure in mechanically ventilated patients in the ICU. In addition, chest physiotherapy could also significantly improve the rapid shallow breathing index score.

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Association of Extubation Failure and Functional Outcomes in Patients with Acute Neurologic Illness

Abstract: In patients with acute neurological illness, extubation failure is associated with longer ICU and hospital stays but does not impact hospital mortality. Patients with extubation failure may experience a worsening of their functional status over time.

Cited by 20 publications

References 33 publications

Extubation timing and risk of extubation failure in aneurysmal subarachnoid hemorrhage patients

Extubation timing and risk of extubation failure in aneurysmal subarachnoid hemorrhage patients

Predictors for Tracheostomy with External Validation of the Stroke-Related Early Tracheostomy Score (SETscore)

Chest physiotherapy with early mobilization may improve extubation outcome in critically ill patients in the intensive care units

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