What is the optimal rate of failed extubation?

Krinsley, James S.; Reddy, Priyanka; Iqbal, Abid

doi:10.1186/cc11185

Cited by 68 publications

(55 citation statements)

References 6 publications

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“…6 But the lack of practical and wellestablished recommendations is likely to explain the heterogeneous reported extubation failure rate (from 14 to 23%). 7 Rationalizing cough assessment could be one way to improve medical practice, because it would allow the identification of the subgroup of patients with an increased risk of extubation failure. Based on objective cough measurement, one could propose individualized protocols of airway management to avoid re-intubation.…”

Section: Introductionmentioning

confidence: 99%

Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter

et al. 2017

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BACKGROUND: Successful weaning from mechanical ventilation depends on the patient's ability to cough efficiently. Cough peak flow (CPF) could predict extubation success using a dedicated flow meter but required patient disconnection. We aimed to predict extubation outcome using an overall model, including cough performance assessed by a ventilator flow meter. METHODS: This was a prospective observational study conducted from November 2014 to October 2015. Before and after a spontaneous breathing trial, subjects were encouraged to cough as strongly as possible before freezing the ventilator screen to assess CPF and tidal volume (V T ) in the preceding inspiration. Early extubation success rate was defined as the proportion of subjects not re-intubated 48 h after extubation. Diagnostic performance of CPF and V T was assessed by using the area under the curve of the receiver operating characteristic curve. Cut-off values for CPF and V T were defined according to median values and used to describe the performance of a predictive test combining them with risk factors of early extubation failure. RESULTS: Among 673 subjects admitted, 92 had a cough assessment before extubation. For the 81 subjects with early extubation success, the median CPF was ؊67.7 L/min, and median V T was 0.646 L. For the 11 subjects with early extubation failure, the median CPF was ؊57.3 L/min, and median V T was 0.448 L. Area under the curve was 0.61 (95% CI 0.37-0.83) for CPF and 0.64 (95% CI 0.42-0.84) for CPF/V T combined. After dichotomization (CPF < ؊60 L/min or V T > 0.55 L), there was a synergistic effect to predict early extubation success (P < .001). The predictive value of success reached 94.2% for CPF/V T combined. The overall model including pH before extubation < 7.45 reached a 66.7% predictive value of failure. CONCLUSIONS: CPF measured using the flow meter of an ICU ventilator was able to predict extubation success and to build a composite score to predict extubation failure. The results were close to that found in previous studies that used a dedicated flow meter. This could help to identify high-risk subjects to prevent extubation failure. (ClinicalTrials.gov registration NCT02847221.)

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Section: Introductionmentioning

confidence: 99%

Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter

et al. 2017

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“…1 Unfortunately, the prevalence of reintubation is 15% in patients who undergo planned extubation. 2 In high-risk patients, the reintubation rate exceeds 30%. 3 Even worse, mortality rates are much higher in reintubated patients (50%) than in successfully extubated patients (5%).…”

mentioning

confidence: 99%

Semiquantitative Cough Strength Score for Predicting Reintubation After Planned Extubation

Duan

Zhou

Xiao

et al. 2015

American Journal of Critical Care

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Background Semiquantitative cough strength score (SCSS, graded 0-5) and cough peak flow (CPF) have been used to predict extubation outcome in patients in whom extubation is planned; however, the correlation of the 2 assessments is unclear. Methods In the intensive care unit of a universityaffiliated hospital, 186 patients who were ready for extubation after a successful spontaneous breathing trial were enrolled in the study. Both SCSS and CPF were assessed before extubation. Reintubation was recorded 72 hours after extubation. Results Reintubation rate was 15.1% within 72 hours after planned extubation. Patients in whom extubation was successful had higher SCSSs than did reintubated patients (mean [SD] , and 5, respectively. The discriminatory power for reintubation, evidenced by area under the receiver operating characteristic curve, was similar: 0.677 for SCSS and 0.678 for CPF (P = .97). As SCSS increased (from 0 to 1 to 2 to 3 to 4 to 5), the reintubation rate decreased (from 29.4% to 25.0% to 19.4% to 16.1% to 13.2% to 4.1%). Conclusions SCSS was convenient to measure at the bedside. It was positively correlated with CPF and had the same accuracy for predicting reintubation after planned extubation. (American Journal of Critical Care. 2015;24:e86-e90)

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“…SOT devices are used to treat this complication, but they may be inadequate in patients with high inspiratory flow, since they can provide oxygen at flow rates <15 L·min −1 [21,32,33]. RITTAYAMAI et al [34], in a crossover study, compared 30-min interventions with NHF and a non-rebreathing mask in recently extubated patients.…”

Section: No Benefitmentioning

confidence: 99%

“…Post-extubation in the ICU Benefit The incidence of extubation failure in ICU varies between 6% and 47%, with respiratory failure being its most common cause, and is associated with a significant morbidity and mortality more than double that of successful extubation [32]. SOT devices are used to treat this complication, but they may be inadequate in patients with high inspiratory flow, since they can provide oxygen at flow rates <15 L·min −1 [21,32,33].…”

Section: No Benefitmentioning

confidence: 99%

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017

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Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre-and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with "do not intubate" status. In the present review, we differentiate studies that suggest an advantage (benefit) from other studies that do not suggest an advantage (no benefit) compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause.

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What is the optimal rate of failed extubation?

Cited by 68 publications

References 6 publications

Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter

Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter

Semiquantitative Cough Strength Score for Predicting Reintubation After Planned Extubation

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

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