Extubations in the PICU- Where are We Now?
Journal Title: Journal of Intensive and Critical Care - Year 2017, Vol 3, Issue 3
Abstract
In the future, utilization of mechanical ventilation will continue to rise. It is anticipated that mechanical ventilation may be required in up to 50% of critically ill and/or injured infants, children, and adolescents in the PICU. This is due to an expected increase in utilization of life sustaining therapies such as renal replacement therapy, extracorporeal membrane oxygenation, therapeutic hypothermia, and transplantation (bone marrow, stem cell and solid organ) [1]. The rise in the use of these modalities will come at a time when clinicians will be expected to limit expenditures and conserve valuable resources such as bed space, specialized equipment such as ventilators and personnel to support their use. These expectations highlight the need for early and accurate determination of extubation readiness. Both failure to recognize opportunities for extubation (extubation readiness) and unsuccessful attempts at extubation (extubation failure) lead to increased ICU and hospital mortality, prolonged length of stay, and higher hospital costs [1-19]. Extubation failure rates range from 3-30% and usually occur within 24-96 h of extubation [1,3- 4,6-7,9,12-15]. Risk factors associated with extubation failure can be grouped into abnormal respiratory mechanics (impaired muscle strength, effort and gas exchange) [7,12,15]; prolonged duration of mechanical ventilation [1,4,6,13,14]; unfavorable cardiopulmonary interactions [3,6,9,13,15]; altered level of consciousness (delirium, residual sedation and/or ICU acquired weakness) [6,7,9,13]; inability to manage secretions [6,7,9,13]; anatomic abnormalities (upper airway obstruction) [6,7,9,12]; genetic abnormalities [4]; metabolic perturbations [9]; fluid overload [9,13]; and unresolved infection [4,6,9].
Authors and Affiliations
James Laham
Keywords
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- EP ID EP300940
- DOI 10.21767/2471-8505.100093
- Views 51
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