Author Reply: Lung Ultrasound Score—Does It Really Predict Extubation Failure?

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Abstract

How to cite this article: Rajbanshi LK, Bajracharya A, Devkota D. Author Reply-lung Ultrasound Score—Does It Really Predict Extubation Failure? Indian J Crit Care Med 2023;27(11):857–858.

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Most cited references 7

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Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine.

, R D Hubmayer, Stephen Hess … (2001)

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Outcomes of extubation failure in medical intensive care unit patients.

Laurent Brochard, Anatole Harrois, Christian Brun-Buisson … (2011)

Extubation failure is associated with a poor prognosis, but the respective roles for reintubation per se and underlying disease severity remain unclear. Our objectives were to evaluate the impact of failed extubation, whether planned or unplanned, on patient outcomes and to identify a patient subset at risk for extubation failure. Prospective 1-yr observational study with daily data collection. : Thirteen-bed medical intensive care unit in a teaching hospital. Consecutive patients requiring invasive mechanical ventilation were screened and followed until discharge or death. None. Of 168 planned extubations in 340 patients, 26 (15%) failed. Of these 26 patients, seven (27%) had pneumonia and 13 (50%) died after reintubation. Compared with successfully extubated patients, the patients with failed extubation were not significantly different regarding disease severity, mechanical ventilation duration, or blood gas values. Age and underlying diseases were the only factors associated with extubation failure, and extubation failure occurred in 34% of patients >65 yrs with chronic cardiac or respiratory disease compared with only 9% of other patients (p 65 yrs with underlying chronic cardiac or respiratory disease are at high risk for extubation failure and subsequent pneumonia and death. Contrasting with successful extubation, failed planned or unplanned extubation was followed by marked clinical deterioration, suggesting a direct and specific effect of extubation failure and reintubation on patient outcomes.

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Weaning and extubation readiness in pediatric patients.

Christopher Newth, Shekhar Venkataraman, Douglas Willson … (2009)

A systematic review of weaning and extubation for pediatric patients on mechanical ventilation. Pediatric and adult literature, English language. Invited review. Literature review using National Library of Medicine PubMed from January 1972 until April 2008, earlier cross-referenced article citations, the Cochrane Database of Systematic Reviews, and the Internet. Despite the importance of minimizing time on mechanical ventilation, only limited guidance on weaning and extubation is available from the pediatric literature. A significant proportion of patients being evaluated for weaning are actually ready for extubation, suggesting that weaning is often not considered early enough in the course of ventilation. Indications for extubation are even less clear, although a trial of spontaneous breathing would seem a prerequisite. Several indices have been developed in an attempt to predict weaning and extubation success but the available literature would suggest they offer no improvement over clinical judgment. Extubation failure rates range from 2% to 20% and bear little relationship to the duration of mechanical ventilation. Upper airway obstruction is the single most common cause of extubation failure. A reliable method of assessing readiness for weaning and predicting extubation success is not evident from the pediatric literature.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Crit Care Med

Journal ID (iso-abbrev): Indian J Crit Care Med

Journal ID (publisher-id): IJCCM

Title: Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine

Publisher: Jaypee Brothers Medical Publishers

ISSN (Print): 0972-5229

ISSN (Electronic): 1998-359X

Publication date (Print): November 2023

Volume: 27

Issue: 11

Pages: 857-858

Affiliations

[1–3 ]Department of Anesthesiology and Critical Care, Birat Medical College and Teaching Hospital, Morang, Nepal

Author notes

Lalit Kumar Rajbanshi, Department of Anesthesiology and Critical Care, Birat Medical College and Teaching Hospital, Morang, Nepal, Phone: +977 9852030496, e-mail: lalitrajbanshi@ 123456gmail.com

Author information

Lalit Kumar Rajbanshi https://orcid.org/0000-0001-7531-634X

Akriti Bajracharya https://orcid.org/0000-0001-5948-161X

Dikshya Devkota https://orcid.org/0000-0003-1192-1086

Article

DOI: 10.5005/jp-journals-10071-24559

PMC ID: 10626228

PubMed ID: 37936801

SO-VID: 83d03cd9-8ec8-4daa-affe-fe3b8d660f1e

License:

© The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.