Deleterious Effects of Reintubation of Mechanically Ventilated Patients

Abstract

About 15% of long-term mechanically ventilated patients who are removed from mechanical ventilation and extubated require reintubation within 48-72 hours after extubation. The reasons for reintubation can be divided in two groups: reintubation because of either upper airway obstruction or respiratory distress. Some authors have associated reintubation with a higher incidence of ventilator-associated pneumonia and a higher mortality. Studies that have analyzed mortality observed different outcomes depending upon relation with the reason for reintubation. Reintubation because of upper airway obstruction has a similar mortality of succesfully extubated patients, whereas reintubation because of respiratory distress has a mortality rate similar to nonextubated patients. These observations suggest that the principal factor associated with higher mortality associated to reintubation is the clinical condition that requires reintubation and not reintubation itself. At this moment, we only can predict the need for reintubation in unplanned extubations because there is no significant difference between scheduled extubation patients who require reintubation and those who do not require reintubation. Possible factors associated with risk of reintubation include left ventricular failure with resumption of spontaneous breathing, excessive sedation, or respiratory infection. The early management of respiratory distress postextubation may be an attractive time for noninvasive ventilation. Clin Pulm Med 2003;10(4):226-230

Incidence, indication and complications of postoperative reintubation after elective intracranial surgery

“…5,11,21,23 In the same way, we observed that in the postoperative phase following elective intracranial surgery, our patients who were reintubated spent longer times on of mechanical ventilation (P < 0.0001), remained in the ICU for longer times (P < 0.0001), had longer hospital stays (P < 0.0001) and presented higher incidence of respiratory complications (P < 0.0001).…”

“…8,9,18,[20][21][22][23] Nevertheless, we found that a lowered level of consciousness was the main cause of postoperative reintubation following elective intracranial surgery (71.5%). This may relate to the surgical procedure or to another factor relating to the respiratory center consequent to surgical manipulation, which would be likely to lead to hypoventilation and consequent CO 2 elevation, along with a drop in the level of consciousness.…”

Comparison of Proportional Assist Ventilation Plus, T-Tube Ventilation, and Pressure Support Ventilation as Spontaneous Breathing Trials for Extubation: A Randomized Study

“…29 ICU-acquired weakness during mechanical ventilation causes deterioration of global muscle strength, tetraparesis, and reduced respiratory muscle strength, leading to longer mechanical ventilation and failed weaning and extubation. 30 The subjects in this study showed an overall reduction in muscle strength, evidenced in the upper (grade 3) and lower (grade 2) limbs.…”

Noninvasive positive-pressure ventilation in acute respiratory failure

“…40 The main cause of extubation failure is the development of respiratory failure within a few hours. Noninvasive positive-pressure ventilation has been evaluated in the prevention and management of this condition.…”