RETIRADA DE LA VÍA AÉREA ARTIFICIAL: EXTUBACIÓN. REVISIÓN NARRATIVA

Mauro Bosso, Laura Vega, Marco Bezzi, Emiliano Gogniat, Roger Rodrigues La Moglie, Gustavo Plotnikow

Resumen


RESUMEN

La retirada de la vía aérea artificial es un proceso habitual dentro de la unidad de cuidados intensivos que suele acompañar al éxito de la prueba de respiración espontánea. Predecir el resultado de la extubación es un punto controvertido en donde la bibliografía es poco robusta, por lo que la valoración y evaluación de predictores de éxito/falla es de suma importancia para realizar un análisis clínico completo e individualizado del paciente que contemple los beneficios potenciales de la extubación a tiempo, así como como los daños y las consecuencias de una extubación fallida. En esta revisión se describe la evaluación del paciente a extubar, el proceso de extubación propiamente dicho y las complicaciones asociadas a la retirada de la vía aérea artificial. 

ABSTRACT

The removal of artificial airway is a common process in the intensive care unit that often accompanies successful spontaneous breathing trial. Predict the outcome of extubation is a controversial point where the literature is not robust, so the assessment of success / failure predictors is of great importance to perform a complete and individualized clinical analysis of the patient that considers the potential benefits of extubation on time, as well as the damages and consequences of a failed extubation. In this review we describe the evaluation of the patient to be extubated, the extubation process and the complications associated with the withdrawal of the artificial airway.


Palabras clave


Extubation; Mechanical Ventilation; Weaning

Texto completo:

PDF

Referencias


Thille A., Cortes-Puch I, Esteban A, et al. Weaning from the ventilator and extubation in ICU. Curr Opin Crit Care 2013;19:57–64

Tanios M., Nevins M., Hendra K., et al. A randomized, controlled trial of the role of weaning predictors in clinical decision making. Crit Care Med. 2006;34(10):2530-5.

MacIntyre N. Respiratory mechanics in the patient who is weaning from the ventilator. Respir Care. 2005;50(2):275-86

Thille A., Boissier F, Ben Ghezala H, et al. Risk factors for and prediction by caregivers of extubation failure in ICU patients: a prospective study. Crit Care Med. 2015;43(3):613-20

Scheinhorn DJ, Chao DC, Stearn-Hassenpflug M. Liberation from prolonged mechanical ventilation. Crit Care Clin 2002;18:569–595

MacIntyre N. The ventilator discontinuation process: An expanding evidence base. Resp Care. 2013;58(6):1074-1086

MacIntyre N. Evidence-Based guidelines for weaning and discontinuing ventilatory support. A collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. 2001;120 (6): 375-395 SUPPLEMENT

Boles JM1, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J. 200;29(5):1033-56.

Tulaimat A., Mokhlesi B. Accuracy and reliability of extubation decisions by intensivists. Respir Care. 2011;56(7):920-7

Epstein S., and Durbin D. Jr. Should a patient be extubated and placed on noninvasive ventilation after failing a spontaneous breathing trial? Respir Care. 2010;55(2):198-206.

Coplin W, Pierson D, Cooley K, et al. Implications of extubation delay in brain injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000;161(5):1530-6..

Sue, R.D., I. Susanto. Long-term complications of artificial airways. Clin Chest Med. 2003;24(3):457-71.

Epstein SK. Decision to extubate. Intensive Care Med 2002;28(5): 535–546.

Epstein SK. Extubation failure: an outcome to be avoided. Crit Care 2004;8(5):310–312.

Miller RL, Cole RP: Association between reduced cuff leak volume and postextubation stridor. Chest. 1996;110(4):1035-40.

Sandhu RS, Pasquale MD, Miller K, et al. Measurement of endotracheal tube cuff leak to predict postextubation stridor and need for reintubation.. J Am Coll Surg. 2000;190(6):682-7.

Ochoa ME, Marin Mdel C, Frutos-Vivar F, et al. Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis. Intensive Care Med. 2009;35(7):1171-9.

Darmon J-Y, Rauss A, Dreyfuss D, et al. Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone. Anesthesiology. 1992;77(2):245-51.

Kastanos N, Estopa Miro R, Marin Perez A, et al. Laryngotracheal injury due to endotracheal intubation: incidence, evolution and predisposing factors: a prospective long term study. Crit Care Med. 1983;11(5):362-7.

Fisher MM, Raper RF. The ‘cuff-leak’ test for extubation. Anaesthesia. 1992;47(1):10-2.

Rothaar R, Epstein S. Extubation failure: magnitude of the problem, impact on outcomes, and prevention. Curr Opin Crit Care. 2003;9(1):59-66.

Menon N, Joffe AM, Deem S, et al. Occurrence and complications of tracheal reintubation in crit- ically ill adults. Respir Care. 2012;57(10):1555-63.

Smina M, Salam A; Khamiees M, et al. Cough peak flows and extubation outcomes. Chest. 2003;124(1):262-8

Bach JR, Saporito LR. Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure: a different approach to weaning. Chest. 1996;110(6):1566-71.

Duan J1, Liu J2, Xiao M2, et al. Voluntary is better than involuntary cough peak flow for predicting re-intubation after scheduled extubation in cooperative subjects. Respir Care. 2014;59(11):1643-51

Su WL1, Chen YH, Chen CW, Involuntary cough strength and extubation outcomes for patients in an ICU. Chest. 2010;137(4):777-82.

Khamiees M, Raju P, DeGirolamo A, et al. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest. 2001;120(4):1262–1270.

Jubran A, Tobin MJ. Use of flow-volume curves in detecting secretions in ventilator dependent patients. Am J Respir Crit Care Med. 1994;150(3):766–769.

Salam A, Tilluckdharry L, Amoateng-Adjepong Y, et al. Neurologic status, cough, secretions and extubation outcomes. Intensive Care Med. 2004;30(7):1334–1339.

Frutos-Vivar F, Ferguson ND, Esteban A, et al. Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 2006;130(6):1664-1671.

Zhang, Z; Pan, L; Ni, H. Impact of delirium on clinical outcome in critically ill patients: a meta-analysis. General hospital psychiatry 2013;35:105-111.

Stransky, M; Schmidt, C; Ganslmeier, P; et al. Hypoactive delirium after cardiac surgery as an independent risk factor for prolonged mechanical ventilation. Journal of cardiothoracic and vascular anesthesia. 2011;25(6): 968-974.

Siobal, M; Kallet, R; Kivett, V; et al. Use of dexmedetomidine to facilitate extubation in surgical intensive care unit patients who failed previous weaning attempts following prolonged mechanical ventilation: a pilot study. Respiratory Care. 2006;51(5):492-6.

Lat, I; McMillian, W; Taylor, S; et al. The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Crit Care Med. 2009; 37: 1898-1905.

Pun, B; Devlin, J. Delirium monitoring in the ICU: strategies for initiating and sustaining screening efforts. Semin Respir Crit Care Med 2013;34:179-188.

Lin, S; Huang, C; Liu, C; et al. Risk factors for the development of early onset delirium and the subsequent clinical outcome in mechanically ventilated patients. Journal of Critical Care. 2008;23:372- 379.

Dale, C; Kannas, D; Fan, V; et al. Improved analgesia, sedation and delirium protocol associated with decreased duration of delirium and mechanical ventilation. Ann Am Thorac Soc. 2014;11(3): 367-74.

Arpino, PA; Kalafatas, K; Thompson, BT. Feasibility of dexmedetomidine in facilitating extubation in the intensive care unit. Journal of Clinical Pharmacy and Therapeutics. 2008; 33, 25-30.

Shehabi, Y; Nakae, H; Hammond, N; et al. The effect of dexmedetomidine on agitation during weaning of mechanical ventilation in critically ill patients. Anaesth Intensive Care. 2010; 38: 82-90.

Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997; 112(1):186-192.

Capdevila XJ, Perrigault PF, Perey PJ, et al. Occlusion pressure and its ratio to maximum inspiratory pressure are useful predictors for successful extubation following T-piece weaning trial. Chest. 1995;108(2): 482-489.

Mokhlesi B, Tulaimat A, Gluckman T, et al. Predicting Extubation Failure After Successful Completion of a Spontaneous Breathing Trial. Respir Care. 2007;52(12):1710-7.

Frutos-Vivar F, Ferguson ND, Esteban A, et al. Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest. 2006;130(6):1664-71.

Thille AW, Harrois A, Schortgen F et al. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med. 2011;39(12):2612-8.

Suresh NS, Cheese M et al. A survey of the current practice of tracheal extubation in intensive care units in England and Wales. Training suction catheter technique vs. Positive pressure breath technique. Anaesthesia. 2006;61(1):92-93.

Hood J, Doyle A, Carter J, et al. Increasing positive endexpiratory pressure at extubation reduces subglotic secretion aspiration in a bech top model. Nurs Crit Care. 2010;15(5):257-61.

Young Pj, Rollison M. Downward, et al. Leakage of fluid past the traqueal tube cuff in a bench top model. Br J Anaesth. 1997;78(5):557-62.

Scales K, Pilsworth J. A practical guide to extubation. Nurs Stand. 2007;19-25;22(2):44-8.

Guglielminotti J, Constant I, Murat I.. Evaluation of routine tracheal extubation in children: infalting or suctioning technique? Br J Anaesth. 1998;81(5):692-5.

Andreu M, Salvati I, Donnianni M, et al. Effect of applying positive pressure with or without endotracheal suctioning during extubation: A laboratory study. Respir Care. 2014;59(12):1905-11.

American Association for Respiratory Care (AARC). Removal of the endotracheal tube--2007 revision & update. Respir Care. 2007;52(1):81-93.

Epstein S, Ciubotaru R. Independet effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med. 1998;158(2):489-93.

Vallverdu I, Calaf N, Subirana M, et al.: Clinical characteristics, respiratory functional parameters, and outcome of two hour t-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med. 1998;158(6):1855-62.

Esteban A, Alia I, Gordo F, et al.: Extubation outcome after spontaneous breathing trials with t-tube or pressure support ventilation. Am J Respir Crit Care Med. 1997;156(2 Pt 1):459-65.

Francois B, Bellissant E, Gissot V, et al. 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal edema: a randomised double-blind trial. Lancet. 2007;369(9567):1083-9.

Chung YH, Chao TY, Chiu CT, et al. The cuff-leak test is a simple tool to verify severe laryngeal edema in patients undergoing long-term mechanical ventilation. Crit Care Med. 2006;34(2):409-14.

Popat M, Mitchell V, et al. Difficult Airway Society Extubation Guidelines Group. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia. 2012;67(3):318-40.

Artime CA, Hagberg CA. Tracheal Extubation. Respir Care. 2014;59(6):991-1002.

Rassam S, Sandby Thomas M, Vaughan RS, Hall JE. Airway management before, during and after extubation: a survey of practice in the United Kingdom and Ireland. Anaesthesia. 2005;60(10):995-1001.


Enlaces refback

  • No hay ningún enlace refback.


Copyright (c) 2018 REVISTA ARGENTINA DE TERAPIA INTENSIVA

Reservados todos los derechos. Ninguna parte de esta publicación puede ser reproducida en ninguna forma o medio alguno, electrónico o mecánico, incluyendo fotocopias, grabaciones u otros sistemas de información, sin autorización por escrito del titular del Copyright.

Sociedad Argentina de
Terapia Intensiva
Personería Jurídica Nº 2481

Cnel. Niceto Vega 4615/17
CP. 1414. Buenos Aires, Argentina
Tel./Fax. (54-11) 4778-0571/0581

Mail: infosati@sati.org.ar / revistarati@gmail.com

ISSN: 2591-3387