Extubation Of Adult Patients Research Articles

Comparison between dexmedetomidine and lidocaine for attenuation of cough response during tracheal extubation: A systematic review and meta-analysis.

Tracheal extubation often causes cardiovascular and airway responses, potentially resulting in hazardous consequences. It remains unknown whether dexmedetomidine or lidocaine is more effective for cough suppression. Hence, we conducted a systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of dexmedetomidine and lidocaine in reducing cough response after tracheal extubation in adult patients. A thorough search of electronic databases, including PubMed, Embase, Cochrane Library, and Web of Science, was conducted to identify relevant studies (from inception to 31 January 2023). Randomised controlled trials comparing intravenous (IV) dexmedetomidine versus IV lidocaine administration during emergence from anaesthesia to prevent tracheal extubation response in adult patients under general anaesthesia were included. The primary outcome was the incidence of post-extubation cough. Secondary outcomes included emergence time, extubation time, residual sedation, and incidences of bradycardia. Statistical analysis was conducted using RevMan software. The Cochrane risk of bias tool was used to evaluate the potential risk for bias. In total, seven studies with 450 participants were included. There was no statistically significant difference in the incidence of cough between dexmedetomidine and lidocaine groups [Risk Ratio = 0.76; 95% Confidence Interval: 0.46, 1.24]. Emergence and extubation times were not significantly different between the two groups. Meta-analysis revealed a higher incidence of bradycardia and residual sedation in dexmedetomidine compared to the lidocaine group. This meta-analysis found no difference in cough, emergence, and extubation time between dexmedetomidine and lidocaine after tracheal extubation. However, residual sedation and bradycardia were more significant in dexmedetomidine than in lidocaine.

Risk Factors and Clinical Outcomes of Unplanned Reintubation after Planned Extubation in Adult Patients admitted to the Intensive Care Unit after Cardiac Surgery

Purpose : This study aimed to identify risk factors for unplanned reintubation after planned extubation and to analyze the clinical outcomes in patients admitted to the intensive care unit after cardiac surgery.Methods : The study examined patients who underwent intubation and planned extubation admitted to the intensive care unit after cardiac surgery between January 1, 2017, and December 31, 2021. The reintubation group comprised 58 patients underwent unplanned reintubation within 7 days of planned extubation. The maintenance group comprised 116 patients who did not undergo reintubation and were matched with the reintubation group using the rational for matching criteria. Data were collected retrospectively from electronic medical records. We used the independent t-test, Mann-Whitney U test, <i>χ</i><sup>2</sup>-test, Fisher’s exact test, and logistic regression analysis with SPSS/WIN 27.0.Results : The multivariate logistic regression analysis demonstrated that albumin (odds ratio [OR]=0.38, 95% confidence interval [CI]=0.20-0.72), surgery time (OR=1.54, 95% CI=1.20-1.97), PaO<sub>2</sub> before extubation (OR=0.85 per 10 mmHg, 95% CI=0.75-0.97), postoperative arrhythmia (OR=2.82, 95% CI=1.22-6.51), reoperation due to bleeding (OR=4.65, 95% CI=1.27-17.07), and postoperative acute renal failure (OR=2.97, 95% CI=1.09-8.04) were risk factors for unplanned reintubation. The reintubation group had a higher in-hospital mortality rate (<i>χ</i><sup>2</sup>=33.74, <i>p</i>＜.001), longer intensive care unit stay (Z=-7.81, <i>p</i>＜.001), and longer hospital stay than the maintenance group (Z=-8.29, <i>p</i>＜.001).Conclusion : These results identified risk factors and clinical outcomes of unplanned reintubation after planned extubation after cardiac surgery. These findings should be considered when developing and managing an intervention program to prevent and reduce the incidence of unplanned reintubation.

Effect of Two Different Doses of Dexmedetomidine on Extubation Quality Score during Tracheal Extubation in Adult Patients- A Randomised Controlled Trial

Effect of Two Different Doses of Dexmedetomidine on Extubation Quality Score during Tracheal Extubation in Adult Patients- A Randomised Controlled Trial

Incidence, risk factors, and outcomes of unplanned extubation in adult patients in a resource-limited teaching hospital in the Philippines: a cohort study.

ObjectiveWe aimed to determine the incidence, risk factors, and outcomes of unplanned extubation among adult patients.MethodsWe conducted a prospective cohort study of adult intubated patients admitted to the charity wards of a government tertiary teaching hospital in the Philippines. Patients managed in both intensive care and nonintensive care settings were included. Patients were followed-up until discharge or until seven days postextubation.ResultsThe outcomes of the 191 included patients were planned extubation (35%), unplanned extubation (19%), death (39%), and discharge against advice (7%). Competing risk regression showed that male sex (Crude OR: 2.25, 95%CI: 1.10 - 4.63) and age (Crude OR 0.976, 95%CI: 0.957 - 0.996) were significant baseline factors. The night shift (Crude OR: 24.6, 95%CI: 2.87 - 211) was also consistently associated with more unplanned extubations. Among postextubation outcomes, reintubation (unplanned extubation: 61.1% versus planned extubation: 25.4%), acute respiratory failure (unplanned extubation: 38.9% versus planned extubation: 17.5%), and cardiovascular events (unplanned extubation: 8.33% versus planned extubation: 1.49%) occurred significantly more often among the unplanned extubation patients. Admission in an intensive care unit was not associated with a lower risk of unplanned extubation (Crude OR 1.15, 95%CI: 0.594 - 2.21).ConclusionMany intubated patients had unplanned extubation. Patients admitted in nonintensive care unit settings did not have significantly higher odds of unplanned extubation.

Risk factors Associated to Extubation Failure in Adult Patients in an Intensive Care Unit of the City of Cali

Objective: To identify risk factors associated with failed extubation in adult patients hospitalized in an intensive care unit of a level III hospital of Cali, during the period of June 2012 to June 2014. Materials and methods: Case-control study of adult patients requiring mechanical ventilation greater than 48 hours. Patients who failed extubation (cases) were compared with patients who were successfully extubated (control), age, oxygenation index PaO2/FIO2, fluid balance, hemoglobin, days of mechanical ventilation, type of weaning and mortality were analyzed. Results: The study population consisted of 130 patients, of whom 26 (20%) had failed extubation (cases). There were no significant differences between the groups regarding age, gender, diagnosis and comorbidities. Prolonged weaning was the only factor associated with failed extubation 3,17 (95% ci 1,01-9,90). No statistically significant relationship between PaO2/FIO2, Hb, fluid balance or Apache II scale and the occurrence of failed extubation were observed. Mortality was higher in the case group (23,1% vs 2,9%) with an or 10,1 (95% ci 1,9-65,8). Conclusions: Prolonged weaning was the only factor associated with extubation failure. The risk of dying from a patient with a failed extubation was 10 times the risk of a patient with a successful extubation.

Sevoflurane in combination with remifentanil for tracheal extubation after otologic surgery.

The effects of i.v. remifentanil in combination with an inhaled anesthetic to facilitate tracheal extubation of deeply anesthetized adults after otologic surgery are investigated. Fifty patients undergoing middleear surgery were recruited for the study. All patients were administered deep anesthesia (i.v. fentanil, propofol, and mivacurium) and intubated, with subsequent administration of inhaled sevoflurane for anesthesia maintenance. Prior to endotracheal tube removal, the patients received i.v. dexamethasone, ondansetron hydrochloride, and parecoxib and were randomly allocated to two groups. In group S (n = 25), anesthesia was maintained with sevoflurane alone (1.3 times the minimum effective alveolar concentration [MAC]), while patients in group SR (n = 25) received low-dose i.v. remifentanil and a reduced dose of sevoflurane (1.0 MAC). The mean remifentanil dosage was 0.028 μg/kg per minute. Relative to patients in group S, patients in group SR had a significantly lower mean respiratory rate (6.4 breaths per minute versus 15.8 breaths per minute, p < 0.01) and end-tidal carbon dioxide pressure (48.1 mm Hg versus 52.1 mm Hg, p < 0.05) after extubation. Postextubation airway obstructions requiring nasal airway placement were less frequent in group SR (14 cases versus 2 cases in group S, p < 0.05); patients in group SR also had a shorter mean time to awakening (19.5 minutes versus 15.8 minutes, p < 0.05) and a shorter mean time to orientation (31.4 minutes versus 26.1 minutes, p < 0.05). Sevoflurane combined with remifentanil provided rapid recovery and appeared to be safe for deep-anesthesia tracheal extubation in adult patients after otologic surgery.

Pro: Early Extubation Following Surgery for Congenital Heart Disease

EARLY EXTUBATION in adult patients undergoing cardiac surgery has been shown to be safe and to decrease resource use. 1 Myles P.S. Daly D.J. Djaiani G. et al. A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. Anesthesiology. 2003; 99: 982-987 Crossref PubMed Scopus (45) Google Scholar , 2 Cheng D.C. Fast track cardiac surgery pathways: Early extubation, process of care, and cost containment. Anesthesiology. 1998; 88: 1429-1433 Crossref PubMed Scopus (135) Google Scholar , 3 Cheng D.C. Karski J. Peniston C. et al. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: A prospective randomized controlled trial. J Thorac Cardiovasc Surg. 1996; 112: 755 Abstract Full Text Full Text PDF PubMed Scopus (308) Google Scholar , 4 Cheng D.C. Fast-track cardiac surgery: Economic implications in postoperative care. J Cardiothorac Vasc Anesth. 1998; 12: 72-79 Abstract Full Text PDF PubMed Scopus (89) Google Scholar Despite several large studies showing that this practice can be extended to pediatric patients undergoing surgery for congenital heart disease (CHD), there is still a significant amount of controversy. Some centers attempt extubation as soon as possible, whereas others routinely sedate patients after surgery. A quick literature search shows that early extubation in children undergoing surgery for CHD had been introduced in the late 1970s. 5 Barash P.G. Lescovich F. Katz J.D. et al. Early extubation following pediatric cardiothoracic operation: A viable alternative. Ann Thorac Surg. 1980; 29: 228-233 Abstract Full Text PDF PubMed Scopus (86) Google Scholar , 6 Schuller J.L. Bovill J.G. Nijveld A. et al. Early extubation of the trachea after open heart surgery for congenital heart disease A review of 3 years' experience. Br J Anaesth. 1984; 56: 1101-1108 Crossref PubMed Scopus (64) Google Scholar , 7 Heard G.G. Lamberti J.J. Park S.M. et al. Early extubation after surgical repair of congenital heart disease. Crit Care Med. 1984; 13: 830-832 Crossref Scopus (48) Google Scholar Several large studies and case series have since proved that early extubation can be performed safely in simple and complex surgical cases for all age groups, including neonates. 8 Mittnacht A.J. Thanjan M. Srivastava S. et al. Extubation in the operating room after congenital heart surgery in children. J Thorac Cardiovasc Surg. 2008; 136: 88-93 Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar , 9 Kloth R.L. Baum V.C. Very early extubation in children after cardiac surgery. Crit Care Med. 2002; 30: 787-791 Crossref PubMed Scopus (69) Google Scholar , 10 Heinle J.S. Diaz L.K. Fox L.S. Early extubation after cardiac operations in neonates and young infants. J Thorac Cardiovasc Surg. 1997; 114: 413-418 Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar , 11 Vricella L.A. Dearani J.A. Gundry S.R. et al. Ultra fast track in elective congenital cardiac surgery. Ann Thorac Surg. 2000; 69: 865-871 Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar , 12 Neirotti R.A. Jones D. Hackbarth R. et al. Early extubation in congenital heart surgery. Heart Lung Circ. 2002; 11: 157-161 Abstract Full Text PDF PubMed Scopus (60) Google Scholar The term “early extubation” typically is applied when patients are extubated within 6 to 8 hours after surgery but also includes extubation in the operating room (OR) at the end of the surgical procedure. Early extubation typically is part of a fast-tracking regimen with the goal of early patient mobilization and intensive care unit (ICU) and hospital discharge, with benefits that are well documented and that will be discussed in detail below.

Poor performance of the pediatric airway exchange catheter in adults with cervical spine immobilization

Use of a pediatric airway exchange catheter (PAEC) has been advocated as a potentially useful adjunct for difficult extubations. We evaluated the laryngeal passing ability of a tracheal tube over a PAEC and compared its success rate between adult patients in the sniffing position and adult patients with simulated cervical spine immobilization created using a manual in-line axial stabilization (MIAS) technique. A total of 100 adult patients were randomized into two groups of equal size with respect to position during the simulated reintubation trial: the MIAS position (Group M) and the sniffing position (Group S). After induction of anesthesia, an 11-F PAEC was placed in the trachea under direct laryngoscopic view, and a wire-reinforced tube (with its bevel facing to the left) was gently railroaded over the PAEC and into the trachea. If insertion was impeded, a second attempt was made after rotating the tube 90 degrees counterclockwise. If this also failed, one additional attempt was made using external laryngeal pressure before changing to conventional laryngoscopic intubation. After the second attempt, the cumulative success rates in Groups M and S were 41.3% and 72.3%, respectively (P = 0.003). After three attempts, the overall success rate was significantly lower in Group M (52.2%) than in Group S (76.6%) (P = 0.018). Owing to the high failure rate of PAEC-guided intubation in patients with simulated cervical spine immobilization, use of a PAEC is not recommended for maintaining continuous airway access after extubation in adult patients with cervical immobility or instability.

Pediatric airway exchange catheter can be a life-saving device for adult patients who have risk factors for difficult tracheal reintubation

Reintubation of the critically ill patients who have risk factors for difficult intubation can be extremely challenging, often resulting in considerable morbidity and mortality. The aim of this study is to determine the usefulness of a pediatric airway exchange catheter (PAEC) prior to tracheal extubation of adult patients who were known to have difficult tracheal intubations and/or have risk factors such as airway obstruction for difficult reintubation.