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

@article{Navalesi2008RateOR,
  title={Rate of reintubation in mechanically ventilated neurosurgical and neurologic patients: Evaluation of a systematic approach to weaning and extubation},
  author={Paolo Navalesi and Pamela Frigerio and Maria Pia Moretti and Maurizio Sommariva and Sergio Vesconi and Paola Baiardi and Anna Levati},
  journal={Critical Care Medicine},
  year={2008},
  volume={36},
  pages={2986-2992}
}
Objective:To assess whether a systematic approach to weaning and extubation (intervention) is superior to the sole physician’s judgment (control) in preventing reintubation secondary to extubation failure in patients with neurologic disorders. Design:Randomized controlled trial. Setting:Intensive care unit of a large teaching hospital. Patients:Three hundred eighteen intubated patients who had been receiving mechanical ventilation for at least 12 hrs and were able to trigger the ventilator… 
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119 Citations

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A systematic approach to disconnect tracheotomized neurological and neurosurgical patients off the ventilator is superior to the sole physician’s judgment (intervention) and a reduction of the rate of failure within 48 h from 15 to 5 %.
A comprehensive protocol for ventilator weaning and extubation: a prospective observational study
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The rates of PERF, reintubation, and hospital mortality were lower than those in previous reports even with nearly the same degree of severity at extubation.
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TLDR
Protocol-directed weaning reduces weaning time, MV duration, length of NCU stay and NCU cost in neurological patients, and these effects are more significant in conscious patients than in unconscious patients.
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TLDR
The ability to follow four commands and other examination criteria were strongly associated with extubation success in this observational study, and modeling suggests that specific neurologic examination parameters provide additional predictive information over GCS alone.
Weaning predictors do not predict extubation failure in simple-to-wean patients.
A Multifaceted Extubation Protocol to Reduce Reintubation Rates in the Surgical ICU.
Postextubation airway obstruction from occult laryngeal mass.
TLDR
It is important to identify patients who require reintubation in a timely fashion to decrease mortality associated with postextubation.
Reintubation Rate and Mortality After Emergent Airway Management Outside the Operating Room
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The reintubation rate was high, reaching 18%, in intubations performed outside-OR and is associated with a significant increase in hospital and ICU-stay.
Airway Management Strategies for Brain‐injured Patients Meeting Standard Criteria to Consider Extubation. A Prospective Cohort Study
TLDR
Extubation success was predicted by younger age, presence of cough, and negative fluid balance, rather than GCS score at extubation, and these results do not support prolonging intubation solely for low G CS score in brain‐injured patients.
Physiotherapy contributions to weaning and extubation of patients from mechanical ventilation
TLDR
South African physiotherapists’ contributions towards weaning of patients from MV through prescription of exercise therapy, early out of- bed mobilisation and DBEs is evidence based.
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