How to prevent postextubation respiratory failure.
| Autor: | Hernández G; Toledo University Hospital, Toledo.; Ciber Enfermedades Respiratorias (CIBERES), Health Institute Carlos III.; Grupo de Investigación en Disfunción y Fallo Orgánico en la Agresión (IdiPAZ).; Universidad Alfonso X el Sabio, Madrid, Spain., Hill NS; Division of Pulmonary, Critical Care and Sleep Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Current opinion in critical care [Curr Opin Crit Care] 2024 Nov 05. Date of Electronic Publication: 2024 Nov 05. |
| DOI: | 10.1097/MCC.0000000000001230 |
| Abstrakt: | Purpose of Review: Postextubation respiratory support treatment approaches, indications, and subgroups of patients with different responses to those therapies are rapidly changing. Planning optimal therapy in terms of choosing devices, timing of application and selecting settings with the goal of minimizing extubation failure is becoming a challenge. This review aims to analyze all the available evidence from a clinical point of view, trying to facilitate decision making at the bedside. Recent Findings: There is evidence for high flow nasal cannula support in patients at low risk of extubation failure. Noninvasive ventilation based strategies should be prioritized in patients at very high risk, who are obese or are hypercapnic at the end of a spontaneous breathing trial. Patients not included in the previous groups merit a tailored decision based on more variables.Optimizing the timing of therapy can include facilitation of extubation by transitioning to noninvasive respiratory support or prolonging a planned preventive therapy according to clinical condition. Summary: Planning postextubatin respiratory support must consider the risk for failing and the presence of some clinical conditions favoring noninvasive ventilation.Extubation can be safely accelerated by modifying screening criteria and spontaneous breathing trial settings, but there is room to increase the role of postextubation noninvasive respiratory support for this indication, always keeping in mind the dangers of delaying a needed intubation. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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