Tag: extubation
Replacement of Fentanyl Infusion by Enteral Methadone Decreases the Weaning Time From Mechanical Ventilation
The introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients resulted in a decrease in the weaning time from mechanical ventilation (MV). A double-blind randomized... read more
Ventilator Weaning and Discontinuation Practices for Critically Ill Patients
In this observational study of invasive mechanical ventilation discontinuation in 142 ICUs in Canada, India, the UK, Europe, Australia/New Zealand, and the US from 2013 to 2016, weaning practices varied internationally. Among... read more
International Variation in Intubation and Extubation Practices Among Critically Ill Patients Receiving Mechanical Ventilation
Requiring invasive mechanical ventilation acutely outside an operating room is, for many, the definition of critical illness. Although there may be debate regarding whether patients treated with noninvasive ventilation or... read more
Natriuretic Peptide–driven Fluid Management during Ventilator Weaning
Our results suggest that a BNP-driven fluid management strategy decreases the duration of weaning without increasing adverse events, especially in patients with left ventricular systolic dysfunction. In a randomized controlled... read more
High Breath-by-Breath Variability Is Associated With Extubation Failure in Children
High respiratory variability during spontaneous breathing trials is independently associated with extubation failure in children, with very high rates of extubation failure when these children develop postextubation upper... read more
The Utility of Diaphragm Ultrasound in Reducing Time to Extubation
Predicting the optimal time for extubation is challenging, especially in patients with underlying diaphragm dysfunction. Incorporating ultrasound information on diaphragm function into usual care allowed clinicians to identify... read more
Use of Supraglottic Airways During COVID-19 Pandemic
This document is produced in response to questions about the use of supraglottic airways (SGAs) during the current pandemic. The advice that it contains is based on the expert opinion of airway specialists and is meant to... read more
Compliance With Evidence-Based Processes of Care After Transitions Between Staff Intensivists
No significant impact of transitions of care observed between individual staff physicians on evidence-based processes of care for mechanically ventilated adult patients. However, transitions were associated with a lower likelihood... read more
Holding Intubated Infants Well Tolerated and Safe
Critically ill infants who are old enough to move on their own but too young to cooperate with care instructions have been among the last to benefit from patient mobility initiatives. Results from a holding intervention... read more
Changes in Anesthetic and Postoperative Sedation-Analgesia Practice Associated With Early Extubation Following Infant Cardiac Surgery
The implementation of an early extubation clinical practice guideline resulted in a reduction in the dose of opioids and benzodiazepines without a change in volatile anesthetic agent used in the operating room. Intraoperative... read more
Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure
Among patients requiring mechanical ventilation in whom a spontaneous breathing trial had failed, early extubation to noninvasive ventilation did not shorten time to liberation from any ventilation. Among 364 randomized... read more
Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Ventilation
This complex randomized, controlled trial failed to demonstrate that early extubation to non-invasive ventilation reduced the total time of mechanical ventilation. I will continue to extubate early and will use non-invasive... read more
Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients
Liberating patients from ongoing invasive mechanical ventilation is typically a 3-step process. First, clinicians must recognize that patients may no longer require mechanical ventilation, when the reasons for intubation... read more
Safety and Efficacy of VBF in Critically Ill, Mechanically Ventilated Adults Using the PERFECT Protocol
Underfeeding in critical illness is common and associated with poor outcomes. According to large prospective hospital studies, volume-based feeding (VBF) safely and effectively improves energy and protein delivery to critically... read more
Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in ICU Patients Without ARDS
In patients in the Intensive Care Unit (ICU) without acute respiratory distress syndrome (ARDS) who were expected not to be extubated within 24 hours of randomization, a low tidal volume strategy did not result in a greater... read more
Risk Stratification Using Oxygenation in the First 24 Hours of Pediatric ARDS
Oxygenation measured 24 hours after acute respiratory distress syndrome onset more accurately stratifies risk, relative to oxygenation at onset, in both children and adults. However, waiting 24 hours is problematic, especially... read more
RBC Transfusions Are Associated With Prolonged Mechanical Ventilation in Pediatric ARDS
RBC transfusion was independently associated with longer duration of mechanical ventilation in pediatric acute respiratory distress syndrome. Hemoglobin transfusion thresholds should be tested specifically within pediatric... read more
A Familiar Story: Delirium in the Acute Care Setting
A few years ago, I received report that a patient was ready to be weaned from the ventilator. He had no respiratory need for mechanical ventilation, and every time the medical team attempted to wean sedation to extubate,... read more
Tracheal extubation with a predicted difficult airway
Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation... read more
Sevoflurane for the treatment of refractory status epilepticus in the critical care unit
A 50-year-old woman with liver failure was admitted to critical care for refractory status epilepticus (RSE). Following tracheal intubation, sevoflurane was administered via the MIRUS system (Pall Medical, Dreieich, Germany).... read more
Weaning from the Ventilator and Extubation in ICU
Current research is focusing on preventing extubation failure, especially in the most challenging cases. The use of weaning protocols – written or computerized – attempts to early identify patients who are able to breathe... read more
