Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. A different approach to weaning

Chest
J R Bach, L R Saporito

Abstract

The purpose of this study was to prospectively compare parameters that might predict successful translaryngeal extubation and tracheostomy tube decannulation. Irrespective of ventilatory function, 62 extubation/decannulation attempts were made on 49 consecutive patients with primarily neuromuscular ventilatory insufficiency who satisfied criteria. Thirty-four patients required 24-h ventilatory support. Noninvasive intermittent positive pressure ventilation (IPPV) was substituted as needed for IPPV via translaryngeal or tracheostomy tubes. Successful decannulation was defined as extubation or decannulation and site closure with no consequent respiratory symptoms or blood gas deterioration for at least 2 weeks. Failure was defined by the appearance of respiratory distress and decreases in vital capacity and oxyhemoglobin saturation despite use of noninvasive IPPV and assisted coughing. The independent variables of age, extent of predecannulation ventilator use, vital capacity, and peak cough flows (PCF) were studied to determine their utility in predicting successful extubation and decannulation. Only the ability to generate PCF greater than 160 L/min predicted success, whereas inability to generate 160 L/min predicted the need t...Continue Reading

Associated Clinical Trials

Citations

Jul 12, 2002·Pediatric Pulmonology·John R BachBrian Weaver
Apr 11, 2003·Journal of the Neurological Sciences·E ServeraJ Marín
Apr 24, 2001·Clinics in Chest Medicine·N Hill
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Apr 25, 2012·The Journal of Spinal Cord Medicine·John R Bach
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Mar 17, 2012·Critical Care : the Official Journal of the Critical Care Forum·Miguel R GonçalvesJosé Artur Paiva
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Jul 14, 2000·Chest·S W Kang, J R Bach
Jul 20, 2002·American Journal of Physical Medicine & Rehabilitation·Adrián Alejandro SuárezEduardo Luis De Vito
Jun 24, 2004·American Journal of Physical Medicine & Rehabilitation·John Robert Bach, Miguel Goncalves
Jul 28, 2004·American Journal of Physical Medicine & Rehabilitation·Jesús SanchoJulio Marín
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May 23, 2008·American Journal of Physical Medicine & Rehabilitation·Carlo Bianchi, Paola Baiardi
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Sep 15, 2015·The Journal of Asthma : Official Journal of the Association for the Care of Asthma·Daphna VilozniOri Efrati

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