Extubation failure in intensive care unit: Predictors and management

outcome.To predict "extubation failure" is essential, as both delayed and failed extubation have detrimental consequences such as prolonged ventilation and ICU stay, need for tracheostomy, increased cost of treatment and mortality.[5][6][7] In this review, we discuss causes, outcomes, predictors and management of extubation failure in patients passing spontaneous breathing trial (SBT). Incidence and Consequences of Extubation FailureIncidence of extubation failure [Table 1] varies between 6 and 47%.[3,8,9] Epstein [3] and Gowardman [10] found that patients needing reintubation had signifi cantly increased duration of mechanical ventilation as well as ICU and hospital LOS and mortality.The OUTCOMERA study group [11] found a signifi cant increase in the incidence of nosocomial pneumonia with consequent increase in the duration of mechanical ventilation, hospital and ICU LOS, Review Article Extubation failure in intensive care unit: Predictors and management Atul P. Kulkarni, Vandana Agarwal 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.