Unplanned Extubation: Appendix
Our data suggest that patients receiving an FI02 >0.40 are at high risk for respiratory failure after unplanned extubation, while those receiving an FI02 <0.40 can be safely observed after such an event.
Total ventilatory support before to unplanned extubation, estimated by We, was also significantly higher in the RI group other generic allegra. This parameter was shown previously to correlate with successful weaning from prolonged mechanical ventilation. From our data, it appears that patients with a We >7 L/min will likely require reintubation following unplanned extubation; however, a significant portion of those with an We <7 L/min do well without reintubation and should be observed.
Pre-extubation minute ventilation (total Ve) was not significantly different between the two groups, and all patients in the NRI group had a Ve >10 L/min prior to unplanned extubation. This is somewhat surprising as Ve <10 L/min has been well-studied as a criterion for planned discontinuation of mechanical ventilation. Also notable is that the duration of intubation did not differ significantly between the two groups. Based on the observed mean values of Ve , duration of intubation, and PEEP, a power analysis revealed that our study lacked sufficient patient numbers to detect significant differences between the two groups. Additionally, we may have failed to identify other predictive parameters because of our small sample size.
Some of the data suggest that our findings may not be generalizable to all mechanically ventilated patients. First, our sample size was small and was limited to MICU patients; surgical patients may behave differently from our patients. Second, the majority of the patients in the NRI group suffered from toxic ingestion with respiratory depression as the cause of respiratory failure, ie, there was no clinical or radiographic evidence of pulmonary disease. Finally, two of the five patients in the NRI group were receiving flow-by ventilation mode, which provides airway protection in the setting of respiratory depression, not as part of a weaning trial). These patients were not actually supported by mechanical ventilation. However, we believed it was appropriate to include these patients in the study, as the analysis addresses reintubation per se. Although our findings may ultimately be useful guidelines in the decision to rein-tubate a patient after unplanned extubation, they should be validated in prospective studies.
In conclusion, it is apparent that unplanned extubation occurs commonly in mechanically ventilated patients and is difficult to prevent. Our data suggest that a pre-extubation FI02 of <0.40 and ventilator-delivered minute ventilation of <7 L/min may be useful in distinguishing those who will remain extu-bated from those who will ultimately require reintubation.