University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy; Clinical Department of Anaesthesiology and Intensive Care Medicine, SS. Annunziata Hospital, Chieti, Italy.
University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy.
Lancet Respir Med. 2018 Dec;6(12):948-962. doi: 10.1016/S2213-2600(18)30375-8.
The periextubation period represents a crucial moment in the management of critically ill patients. Extubation failure, defined as the need for reintubation within 2-7 days after a planned extubation, is associated with prolonged mechanical ventilation, increased incidence of ventilator-associated pneumonia, longer intensive care unit and hospital stays, and increased mortality. Conventional oxygen therapy is commonly used after extubation. Additional methods of non-invasive respiratory support, such as non-invasive ventilation and high-flow nasal therapy, can be used to avoid reintubation. The aim of this Review is to describe the pathophysiological mechanisms of postextubation respiratory failure and the available techniques and strategies of respiratory support to avoid reintubation. We summarise and discuss the available evidence supporting the use of these strategies to achieve a tailored therapy for an individual patient at the bedside.
拔管后时期是危重症患者管理中的一个关键阶段。拔管失败的定义为计划拔管后 2-7 天内需要再次插管，与机械通气时间延长、呼吸机相关性肺炎发生率增加、重症监护病房和住院时间延长以及死亡率增加有关。常规氧疗常用于拔管后。非侵入性呼吸支持的其他方法，如无创通气和高流量鼻导管治疗，可用于避免再次插管。本综述旨在描述拔管后呼吸衰竭的病理生理机制以及可用的呼吸支持技术和策略，以避免再次插管。我们总结和讨论了支持使用这些策略的现有证据，以实现个体化患者床边的针对性治疗。
