Department of Anesthesiology & Pain Medicine, Harborview Medical Center, Seattle, Washington.
Banner MD Anderson Cancer Center, Gilbert, Arizona, USA.
Curr Opin Anaesthesiol. 2022 Apr 1;35(2):122-129. doi: 10.1097/ACO.0000000000001119.
Extubation in the intensive care unit (ICU) is associated with a failure rate requiring reintubation in 10-20% patients further associated with significant morbidity and mortality. This review serves to highlight recent advancements and guidance on approaching extubation for patients at risk for difficult or failed extubation (DFE).
Recent literature including closed claim analysis, meta-analyses, and national society guidelines demonstrate that extubation in the ICU remains an at-risk time for patients. Identifiable strategies aimed at optimizing respiratory mechanics, patient comorbidities, and airway protection, as well as preparing an extubation strategy have been described as potential methods to decrease occurrence of DFE.
Extubation in the ICU remains an elective decision and patients found to be at risk should be further optimized and planning undertaken prior to proceeding. Extubation for the at-risk patient should be operationalized utilizing easily reproducible strategies, with airway experts present to guide decision making and assist in reintubation if needed.
重症监护病房（ICU）的拔管与失败率有关，10-20%的患者需要再次插管，这进一步导致了显著的发病率和死亡率。本篇综述旨在强调最近在处理有困难或失败拔管（DFE）风险的患者的拔管方法方面的进展和指导。
包括封闭索赔分析、荟萃分析和国家学会指南在内的最新文献表明，ICU 中的拔管仍然是患者面临风险的时期。已经描述了一些明确的策略，旨在优化呼吸力学、患者合并症和气道保护，并制定拔管策略，这些方法可能有助于减少 DFE 的发生。
在 ICU 中进行拔管仍然是一项选择性决定，如果发现患者有风险，应在继续进行之前进一步优化并进行计划。对于高危患者的拔管，应采用易于复制的策略进行操作，同时气道专家在场，以指导决策，并在需要时协助重新插管。
