Tag: extubation
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
An Exploratory Reanalysis of the Randomized Trial on Efficacy of Corticosteroids as Rescue Therapy for the Late Phase of ARDS
During active intervention, methylprednisolone was safe and effective in achieving disease resolution. Our findings support rapid glucocorticoid discontinuation post extubation as likely cause of disease relapse. Gradual... read more
An Interprofessional Quality Improvement Initiative to Standardize Pediatric Extubation Readiness Assessment
An interprofessionally developed respiratory therapist–led extubation readiness protocol can be successfully implemented in a busy tertiary care PICU without adverse events. We analyzed data from 398 mechanically ventilated... read more
Does a 1-h Rest After a Successful SBT Really Improve Extubation Outcome?
Discussion on whether reconnection to mechanical ventilation for 1h after a successful spontaneous breathing trial (SBT) reduces reintubation in critically ill patients: a multicenter randomized controlled trial.... read more
Focus on Ventilation and Airway Management in the ICU
Airway and ventilation management are particularly challenging in the intensive care unit (ICU), and are associated with high morbidity and mortality. Figure summarizes some of the more recent findings from the literature.... read more
Quality initiative reduced the number of chest X-rays conducted in the NICU
A quality improvement initiative implemented at Washington, D.C.-based Children's National Health System successfully reduced the number of chest X-rays conducted in the neonatal intensive care unit, decreasing the risk of... read more
Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients
This prospective observational multicentre study (ARREVE) was done in 43 French ICUs to compare terminal weaning and immediate extubation, as chosen by the ICU team. Terminal weaning was a gradual decrease in the amount of... read more
An Airway Risk Assessment Score for Unplanned Extubation in PICU
Higher Risk Assessment Scores are associated with occurrence rates of unplanned extubation. As a result of a workshop to identify common causes of unplanned extubation, Children's Healthcare of Atlanta developed a scoring... read more
Trials directly comparing alternative spontaneous breathing trial techniques
The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain. Patients undergoing PS (vs T-piece) SBTs appear to be 6% (95% CI 2–10%)... read more
ICU Study Shows Significant Reduction in Time to Blood Gas Result using Sphere Medical’s Proxima
A recent time and motion study by University Hospital Southampton demonstrated a 1.5 minute (>20%) reduction in time to blood gas results when using the Proxima bedside blood gas monitoring system. The study also found... read more
Ultra-Short-Course Antibiotics for Patients With Suspected Ventilator-Associated Pneumonia but Minimal and Stable Ventilator Settings
Many patients started on antibiotics for possible ventilator-associated pneumonia (VAP) do not have pneumonia. Patients with minimal and stable ventilator settings may be suitable candidates for early antibiotic discontinuation.... read more
Liberation from Mechanical Ventilation in Critically Ill Adults
Official Executive Summary of an American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. The panel provides recommendations... read more
The CAPCRI study on Semi-recumbent positioning
The CAPCRI study(3) conducted by Mireia Llaurado and her team had three aims: to evaluate real semi-recumbent position compliance and degree of head-of-bed elevation in Spanish intensive care units, to describe the relationship... read more
Dexmedetomidine Use in Critically-Ill Children with Acute Respiratory Failure
Margaret Parker, MD, MCCM, speaks with Mary Jo C. Grant, APRN, PhD, about the article, "Dexmedetomidine Use in Critically-Ill Children with Acute Respiratory Failure," published in the December 2016 issue of Pediatric... read more
