Rate of reintubation in mechanically ventilated neurosurgical and neurologic patients: Evaluation of a systematic approach to weaning and extubation

Abstract

In patients with neurologic diseases, a systematic approach to weaning and extubation reduces the rate of reintubation secondary to extubation failure without affecting the duration of mechanical ventilation, and is overall positively perceived by intensive care unit professionals.

Patients’ prediction of extubation success

“…The SBT is presently the major diagnostic tool to determine if patients can be successfully extubated [1], and recent recommendations have been made to further increase the likelihood of successful extubation [8][9][10][11][12][13][14][15]. Nonetheless, extubation failure-defined as the need for ventilatory support or death within 48 h following extubation (adapted from [1])-is still prevalent, with reported reintubation rates of up to 19% [1,16,17] and 5-24% for rescue therapy with non-invasive ventilation (NIV) [13][14][15].…”

“…The recommended approaches to evaluate the likelihood of successful extubation rely on objective criteria assessed by the clinician [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Little emphasis has been placed so far on the patients' subjective evaluation of the potential to sustain autonomous breathing, which might be influenced by psychological factors as well as the perceived work of breathing.…”

The Timed Inspiratory Effort: A Promising Index of Mechanical Ventilation Weaning for Patients With Neurologic or Neuromuscular Diseases

“…1 Weaning decisions based solely on expert clinical judgment are not always correct. 3 Previous reports suggest that clinical judgment based on traditional respiratory parameters and the level of neuromuscular impairment [4][5][6][7] may prevent unnecessary delay of withdrawal from mechanical ventilation and mitigate complications such as diaphragm atrophy and weakness. 8,9 A number of procedures to verify patients' readiness for weaning have been proposed.…”

Voluntary Is Better Than Involuntary Cough Peak Flow for Predicting Re-Intubation After Scheduled Extubation in Cooperative Subjects

“…[1][2][3] Nevertheless, 12.4 -21% of patients require re-intubation within 48 -72 h, although they have a successful SBT. [4][5][6][7][8] This results from many reasons, such as weak cough, large amount of secretions, advanced age, impaired neurological status, or laryngospasm. 9,10 Furthermore, re-intubation is associated with a 5-fold increase in the relative odds of death and a 2-fold increase in median ICU and hospital stay, as well as institutional costs.…”