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VOLUME 12 , ISSUE 1 ( March, 2008 ) > List of Articles


Extubation failure in intensive care unit: Predictors and management

Keywords : Extubation, failure of, predictors of, reintubation, weaning

Citation Information : Extubation failure in intensive care unit: Predictors and management. Indian J Crit Care Med 2008; 12 (1):1-9.

DOI: 10.4103/0972-5229.40942

License: CC BY-ND 3.0

Published Online: 01-07-2011

Copyright Statement:  Copyright © 2008; The Author(s).


Extubation failure-need for reintubation within 72 h of extubation, is common in intensive care unit (ICU). It can cause increased morbidity, higher costs, higher ICU and hospital length of stay (LOS) and mortality. Patients with advanced age, high severity of illness at ICU admission and extubation, preexisting chronic respiratory and cardiovascular disorders are at increased risk of extubation failure. Unresolved illness, development and progression of organ failure during the time from extubation to reintubation and reintubation itself have been proposed as reasons for increased morbidity and mortality. Parameters used to predict extubation failure can be categorized into parameters assessing respiratory mechanics, airway patency and protection and cardiovascular reserve. Adequate cough strength, minimal secretions and alertness are necessary for successful extubation. Evidence suggests that early institution of non-invasive ventilation and prophylactic administration of methylprednisolone may prevent reintubation in some patients. The intensivist needs to identify patients at high risk of extubation failure and be prepared to reinstitute ventilation early to prevent adverse outcomes.

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  1. Cough peak flows and extubation outcomes. Chest 2003;124:262-8.
  2. Minute ventilation recovery time: A predictor of extubation outcome. Chest 2003;123;1214-21.
  3. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997;112:186-92.
  4. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med 1997;156:459-65.
  5. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 1998;158:489-93.
  6. The outcome of extubation failure in a community hospital intensive care unit: A cohort study. Crit Care 2004;8:R322-7.
  7. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 1995;152:137-41.
  8. Association between reduced cuff leak volume and postextubation stridor. Chest 1996;110:1035-40.
  9. Comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 1995;332:345-50.
  10. The effect of extubation failure on outcome in a multidisciplinary Australian intensive care unit. Crit Care Resusc 2006;8:328-33.
  11. Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit: A prospective multicenter study. Anesthesiology 2002;97:148-56.
  12. Protocol-driven ventilator weaning reduces use of mechanical ventilation, rate of early reintubation and ventilator-associated pneumonia. J Trauma 2004;56:943-51.
  13. Reintubation as an outcome predictor in trauma patients. Chest 1996;110:1577-80.
  14. Reexamination of the effect of time to reestablishing ventilatory support on outcome for patients failing extubation. Am J Respir Crit Care Med 2001;163:A689.
  15. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med 1999;27:340-7.
  16. Occlusion pressure and its ratio to maximum inspiratory pressure are useful predictors for successful extubation following T-piece weaning trial. Chest 1995;108:482-9.
  17. Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome. Chest 1994;105:540-3.
  18. Early noninvasive ventilation averts extubation failure in patients at risk: A randomized trial. Am J Respir Crit Care Med 2006;173:164-70.
  19. Predictors of successful extubation in neurosurgical patients. Am J Respir Crit Care Med 2001;163:658-64.
  20. Neurologic status, cough, secretions and extubation outcomes. Intensive Care Med 2004;30:1334-9.
  21. Predicting extubation failure after successful completion of a spontaneous breathing trial. Respir Care 2007;52:1710-7.
  22. Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 2006;130:1664-71.
  23. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med 2000;161:1530-6.
  24. Prevalence of myocardial ischemia during mechanical ventilation and weaning and its effects on weaning success. Heart Lung 2006;35:363-73.
  25. Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease. Crit Care Med 2007;35:96-105.
  26. Predicting success in weaning from mechanical ventilation. Chest 2001;120:400S-24S.
  27. Etiology of extubation failure and the predictive value of the rapid shallow breathing index. Am J Respir Crit Care Med 1995;152:545-9.
  28. Predictors of extubation failure in patients with chronic obstructive pulmonary disease. J Crit Care 2006; 21: 185-90.
  29. Stress test and gastric-arterial PCO2 measurement improve prediction of successful extubation. Crit Care Med 2000;28:2313-9.
  30. Assessment of various new predictive parameters of the outcome of mechanical ventilation weaning. Minerva Anestesiol 1996;62:153-64.
  31. Breathing pattern during acute respiratory failure and recovery. Eur Respir J 1997;10:2560-5.
  32. Evaluation of a new method for measurement of minute ventilation recovery time. Respir Care 2006;51:133-9.
  33. Minute ventilation recovery time (V E RT) can predict extubation outcome in surgical patients. Am J Respir Crit Care Med 2002;:A687.
  34. The early phase of the minute ventilation recovery curve predicts extubation failure better than the minute ventilation recovery time. Chest 2007;131:1315-22.
  35. Elevated imposed work of breathing masquerading as ventilator weaning intolerance. Chest 1995;108:1021-5.
  36. Breathing measurement reduces false-negative classification of tachypneic preextubation trial failures. Crit Care Med 1996;24:976-80.
  37. Extubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure. Crit Care Med 2006;34:682-6.
  38. Ultrasonographic evaluation of liver/spleen movements and extubation outcome. Chest 2004;126:179-85.
  39. Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure: A different approach to weaning. Chest 1996;110:1566-71.
  40. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 2001;120:1262-70.
  41. Clinical characteristics, respiratory functional parameters and outcome of a 2-hour t-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med 1999;159:512-8.
  42. When to extubate the croup patient: The “leak” test. Can J Anaesth 1987;34:304-6.
  43. The endotracheal tube cuff-leak test as a predictor for postextubation stridor. Respir Care 2005;50:1632-8.
  44. Post-extubation stridor in intensive care unit patients: Risk factors evaluation and importance of the cuff-leak test. Intensive Care Med 2003;29:69-74.
  45. The cuff leak test to predict failure of tracheal extubation for laryngeal edema. Intensive Care Med 2002;28:1267-72.
  46. Laryngeal ultrasound: A useful method in predicting post-extubation stridor: A pilot study. Eur Respir J 2006;27:384-9.
  47. Hemodynamic responses to successful weaning from mechanical ventilation after cardiovascular surgery. Intensive Care Med 2000;26:1201-6.
  48. Gastric intramural pH as a predictor of success or failure in weaning patients from mechanical ventilation. Ann Intern Med 1993;119:794-8.
  49. Effects of noninvasive positive pressure ventilatory support in non-COPD patients with acute respiratory insufficiency after early extubation. Intensive Care Med 1999;25:1374-80.
  50. Effect of early application of biphasic positive airway pressure on the outcome of extubation in ventilator weaning. Respirology 1999;4:161-5.
  51. Noninvasive positive-pressure ventilation for postextubation respiratory distress: A randomized controlled tria trial. JAMA 2002;287:3238-44.
  52. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 2004;350:2452-60.
  53. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med 2005;33:2465-70.
  54. Noninvasive positive pressure ventilation in the intensive care unit: A concise review. Crit Care Med 2005;33:2651-8.
  55. Does dexamethasone reduce the risk of extubation failure in ventilated children. Arch Dis Child 2006;91:791-3.
  56. Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults. Cochrane Database Syst Rev 2000;2:CD001000.
  57. 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: A randomised double-blind trial. Lancet 2007;369:1083-9.
  58. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Am J Respir Crit Care Med 1999;159: 512-8.
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