For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
10
views
22
references
 Top references
cited by
5
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      282
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: not found

      Pro/con clinical debate: Tracheostomy is ideal for withdrawal of mechanical ventilation in severe neurological impairment

      review-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Most clinical trials on the topic of extubation have involved patients outside the neurological intensive care unit. As a result, in this area clinicians are left with little evidence on which to base their decision making. Although tracheostomies are increasingly common procedures, they are not without complications and costs, and hence a decision to perform them should not be taken lightly. In this issue of Critical Care two groups debate the merits of tracheostomy before extubation in a patient with neurological impairment. What becomes very clear is the need for more high quality data for this common clinical problem.

          Related collections

          Most cited references22

          • Record: found
          • Abstract: found
          • Article: not found

          Implications of extubation delay in brain-injured patients meeting standard weaning criteria.

          Kenneth D Pierson, W M Coplin, K Cooley … (2000)
          We hypothesized that variation in extubating brain injured patients would affect the incidence of nosocomial pneumonia, length of stay, and hospital charges. In a prospective cohort of consecutive, intubated brain-injured patients, we evaluated daily: intubation status, spontaneous ventilatory parameters, gas exchange, neurologic status, and specific outcomes listed above. Of 136 patients, 99 (73%) were extubated within 48 h of meeting defined readiness criteria. The other 37 patients (27%) remained intubated for a median 3 d (range, 2 to 19). Patients with delayed extubation developed more pneumonias (38 versus 21%, p < 0.05) and had longer intensive care unit (median, 8.6 versus 3.8 d; p < 0.001) and hospital (median, 19.9 versus 13.2 d; p = 0.009) stays. Practice variation existed after stratifying for differences in Glasgow Coma Scale scores (10 versus 7, p < 0.001) at time of meeting readiness criteria, particularly for comatose patients. There was a similar reintubation rate. Median hospital charges were $29,057.00 higher for extubation delay patients (p < 0.001). This study does not support delaying extubating patients when impaired neurologic status is the only concern prolonging intubation. A randomized trial of extubation at the time brain-injured patients fulfill standard weaning criteria is justifiable.
          Article 0 comments Cited 106 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Predictors of successful extubation in neurosurgical patients.

            L. Douglas Case, E Ely, Jeffrey F. Kelly … (2001)
            A respiratory therapist-driven weaning protocol incorporating daily screens, spontaneous breathing trials (SBT), and prompts to caregivers has been associated with superior outcomes in mechanically ventilated medical patients. To determine the effectiveness of this approach in neurosurgical (NSY) patients, we conducted a randomized controlled trial involving 100 patients over a 14-mo period. All had daily screens of weaning parameters. If these were passed, a 2-h SBT was performed in the Intervention group. Study physicians communicated positive SBT results, and the decision to extubate was made by the primary NSY team. Patients in the Intervention (n = 49) and Control (n = 51) groups had similar demographic characteristics, illness severity, and neurologic injuries. Among all patients, 87 (45 in the Control and 42 in the Intervention group) passed at least one daily screen. Forty (82%) patients in the Intervention group passed SBT, but a median of 2 d passed before attempted extubation, primarily because of concerns about the patient's sensorium (84%). Of 167 successful SBT, 126 (75%) did not lead to attempted extubation on the same day. The median time of mechanical ventilation was 6 d in both study groups, and there were no differences in outcomes. Overall complications included death (36%), reintubation (16%), and pneumonia (9%). Tracheostomies were created in 29% of patients. Multivariate analysis showed that Glasgow Coma Scale (GCS) score (p or = 8 at extubation was associated with success in 75% of cases, versus 33% for a GCS score < 8 (p < 0.0001). Implementation of a weaning protocol based on traditional respiratory physiologic parameters had practical limitations in NSY patients, owing to concerns about neurologic impairment. Whether protocols combining respiratory parameters with neurologic measures lead to superior outcomes in this population requires further investigation.
            Article 0 comments Cited 78 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support

              Neil R MacIntyre (2001)
              Article 0 comments Cited 70 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): Crit Care
                Title: Critical Care
                Publisher: BioMed Central (London )
                ISSN (Print): 1364-8535
                ISSN (Electronic): 1466-609X
                Publication date (Print): 2004
                Publication date (Electronic): 13 May 2004
                Volume: 8
                Issue: 5
                Pages: 327-330
                Affiliations
                [1 ]Assistant Professor, Dipartimento di Discipline Medico Chirurgiche, Sezione di Anestesiologia e Rianimazione, University of Turin, Turin, Italy
                [2 ]Resident, Dipartimento di Discipline Medico Chirurgiche, Sezione di Anestesiologia e Rianimazione, University of Turin, Turin, Italy
                [3 ]Staff Physician, Dipartimento di Discipline Medico Chirurgiche, Sezione di Anestesiologia e Rianimazione, University of Turin, Turin, Italy
                [4 ]Fellow, Respirology and Critical Care Medicine, University of Toronto, Toronto, Canada
                [5 ]Assistant Professor, Department of Medicine, Division of Respirology, and the Interdepartmental Division of Critical Care Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Canada
                Article
                Publisher ID: cc2864
                DOI: 10.1186/cc2864
                PMC ID: 1065006
                PubMed ID: 15469593
                SO-VID: bdf74278-ea6d-43d9-8632-e55087d8c37d
                Copyright © Copyright © BioMed Central Ltd
                History
                Categories
                Subject: Review

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: weaning,brain injury,intubation,tracheostomy,neurosurgical intensive care
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: weaning, brain injury, intubation, tracheostomy, neurosurgical intensive care

                Comments

                Comment on this article

                scite_

                Similar content282

                See all similar

                Cited by5

                See all cited by

                Most referenced authors396

                See all reference authors